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Environmental Health and Child Survival Epidemiology Economics Experiences ENVIRONMENT AND DEVELOPMENT Environmental Health and Child Survival I O M O M fundamental element of sustainable development is environmental sustainability

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Hence this series was created in to cover current and emerging issues in order to promote debate and broaden the understanding of environmental challenges as integral to achieving equitable and sustained economic growth

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The series will draw on analysis and practical experience from across the World Bank and from client countries

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The manuscripts chosen for publication will be central to the implementation of the World Bank Environment Strategy and relevant to the development community policy makers and academia

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Topics addressed in this series will include environmental health natural resources management strategic environmental assessment policy instruments and environmental institutions

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Also in this series International Trade and Climate Change Economic Legal and Institutional Perspectives Poverty and the Environment Understanding Linkages at the Household Level Strategic Environmental Assessment for Policies An Instrument for Good Governance Environmental Health and Child Survival Epidemiology Economics Experiences The International Bank for Reconstruction and Development The World Bank Street NW Washington DC Telephone Internet www

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worldbank

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org mail feedback worldbank

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org All rights reserved

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The findings interpretations and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent

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The boundaries colors denominations and other information shown on any map in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries

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H N E M N The material in this publication is copyrighted

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Copying and or transmitting portions or all of this work without permission may be violation of applicable law

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The International Bank for Reconstruction and Development The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly

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For permission to photocopy or reprint any part of this work please send request with complete information to the Copyright Clearance Center Inc

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Rosewood Drive Danvers MA USA telephone fax Internet www

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copyright

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All other queries on rights and licenses including subsidiary rights should be addressed to the Office of the Publisher The World Bank Street NW Washington DC USA fax mail pubrights worldbank

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Library of Congress Cataloging in Publication Data Environmental health and child survival epidemiology economics experiences

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Environment and development Includes bibliographical references and index

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Environmentally induced diseases in children Developing countries

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Series Environment and development Washington D

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' dc Cover photo World Bank Photo Library Cover design Auras Design Silver Spring Maryland O S xi xiii Acknowledgments Abbreviations and Acronyms H Epidemiology H Economics H How Environmental Health Supplements Other Child Survival Strategies Adding Value to Health Systems Adapting Environmental Management Programs Adjusting Infrastructure Strategies Key Messages Notes Environmental Health Malnutrition and Child Health Environmental Factors Exposure and Transmission Pathways Vicious Cycle of Infections and Malnutrition Environmental Role in Early Childhood Health Averting Cognition and Learning Impacts Key Messages Note H Introduction Objectives Audience Primer on Environmental Health Primer on Malnutrition Content and Organization How Large Is the Environmental Health Burden

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Burden of Disease Environmental Health Burdens Areas for Future Research vi CONTENTS Key Messages Notes H Estimating the Environmental Health Burden and Costs at the Country Level Existing Practice in Environmental Health Valuation Building New Estimates for Environmental Health Costs Case Studies of Ghana and Pakistan Results for Ghana and Pakistan Conclusion Next Steps Key Messages Notes Experiences H Approaches to Environmental Health History of Environmental Health Agenda Falling through the Cracks Environmental Health Experiences in Developing Countries Understanding the Enabling Environment Governance and Institutional Implications Institutional Requirements for Successful Environmental Health Governance Critical Moment Key Messages Note H Conclusion Contributions of This Report Next Steps Appendixes APPENDIX Technical Review of Cohort Studies Background Search Strategy and Selection Criteria Findings and Discussion Experimental Evidence from Deworming Conclusions Notes APPENDIX Review of Studies on Nutritional Status and Education Diarrhea and Education CONTENTS Conclusions Note APPENDIX New Estimates for Burden of Disease from Water Sanitation and Hygiene APPENDIX Computing Country Level Environmental Health Burden of Disease Mortality Education Notes APPENDIX Methodological Aspects of Assessing Environmental Health Burden of Disease From Relative Risks to Attributable Fractions Dealing with Biased Estimates of Relative Risk Notes APPENDIX Monetary Valuation of the Cost of Environmental Health Risks Note References Index Boxes

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What Is Environmental Health

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Impact of Diarrhea on Child Malnutrition Evidence from Research

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Overweight Mothers Carrying Underweight Children

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Why Percent

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Supporting Evidence from Recent Cohort Studies

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Revisiting the Asian Enigma

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The Mills Reincke Phenomenon

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Basic Indicators for Ghana and Pakistan

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Attributable Fractions and Burden of Disease When Multiple Risk Factors Are Present

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How Policy Makers Should Interpret These Results

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Combating Disease through Improved Milk

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Mexico Multisectorality through Diagonal Approach

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Thailand National Nutrition Program

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Ethiopia The Toilet Revolution

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Vietnam Dengue Program

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Atrophy of Environmental Health Functions in India

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Institutional Evolution of Environmental Health The Case of Ethiopia Figures

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The Diagram Transmission Routes for Infection

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Relationship between Nutrition and Infection vii viii CONTENTS

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Environmental Health Inputs and Health Outcomes in the Child Life Cycle The Window of Opportunity for Addressing Undernutrition Range of Preventive Activities in Child Survival The Health Effects of Environmental Risks Factors Water Related WSH plus WRM Burden of Disease in Children under Five Attributable to Environmental Risk Factors by WHO Region Mills Reincke Ratios for Subregions Cost of Environmental Health Risks Weight for Age Distribution of Children in Ghana and Pakistan Two Week Diarrheal Prevalence Rate by Age and Underweight Status in Ghana and Pakistan Underweight Malnutrition Rates in Children with and without Diarrheal Infections in Ghana and Pakistan Calculating Revised Estimates Indirect and Direct Effects Final Results of Ghana and Pakistan Case Studies Summary of the Methodology Exposure Categories Exposure Categories Population Shares and Relative Risks of ALRI in Ghana Tables

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Millennium Development Goals and Environmental Health

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Annual Cost of Direct and Indirect Impact of Environmental Risk Factors in

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Water Related Transmission Routes and Disease Outcome

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Impact of Infection on Nutritional Status

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Role of Environmental Health in Supplementing Health System Strategies

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Environmental Risk Factors and Related Diseases Included in the Comparative Risk Assessment

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Environmentally Attributable Fractions of Child Mortality Keeping Malnutrition Unchanged

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Estimated Mortality in Under Five Children from Environmental Risk Factors

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Malnutrition Rates in Children under the Age of Five

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Malnutrition Attributable Fractions of Child Mortality

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Environmentally Attributable Fractions and Child Mortality with Malnutrition Mediated Effects

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Effects of Malnutrition on Education

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Annual Cost of Direct and Indirect Effect of Environmental Risk Factors in A

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Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries B

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Studies of the Effects of Malnutrition on Educational Outcomes CONTENTS C

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ix Burden of Disease in DALYs in Children under Five Years Attributable to Water Sanitation and Hygiene by World Health Organization Subregions Causes of Death and Risk Factors Considered in this Study Estimating the Cost of Environmental Health Risks Information Types and Sources Relative Risks by Exposure Categories Assuming Cox Hazard Model Weight Gain Retardation Factors by Age and Score Weight for Age in Children under Five Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana Estimated Mortality in Children under Five from Environmental Risk Factors Ghana Estimated Annual Cost of Education Outcomes from Stunting and Share from Environmental Factors in Ghana Height Growth Retardation Factors by Age and Score Height for Age Rates in Children under Five Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana Parameter Values Applied in Estimation of Income Losses Income Distribution across Malnutrition Categories and Wealth Quintiles in Ghana Annual Cost of Environmental Factors Percentage of GDP in Using Percent Discount Rate Annual Cost of Environmental Factors Percentage of GDP in Using Percent Discount Rate Environmental Risk Factors and Related Diseases Included in the WHO Comparative Risk Assessment Acknowledgments This book is product of the Environmental Health Anchor Program in the Environment Department of the World Bank

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The book was prepared by team led by Anjali Acharya Environmental Specialist ENV World Bank and Mikko K

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Paunio Sr

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Environmental Specialist ENV World Bank under the guidance of Kulsum Ahmed Lead Environmental Specialist and Team Leader Environmental Health Anchor Program ENV World Bank and Laura Tlaiye Sector Manager ENV World Bank

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The core writing team also included Maria Fernanda Garcia Consultant ENV World Bank Monica Das Gupta Sr

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Water Sanitation Specialist ETWWA World Bank Bjorn Larsen Consultant ENV World Bank and Giovanni Ruta Economist ENV World Bank

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Special thanks go to the peer reviewers for this study who included Harold Alderman Advisor AFTHD World Bank Enis Baris Sr

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Health Specialist MNSHD World Bank Sandy Cairncross Professor of Environmental Health London School of Hygiene and Tropical Medicine and Maureen Cropper Professor of Economics University of Maryland

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Sandy continuous and passionate engagement on the content and tone of this book is highly appreciated while Maureen role in providing substantial inputs to the economic costing methodology developed for part of this report is especially recognized

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Additional comments inputs and guidance are gratefully acknowledged from Douglas Barnes Sr

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Energy Specialist ETWES World Bank Caroline van den Berg Sr

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Economist ETWWA World Bank Jan Bojö Lead Environmental Economist ENV World Bank Sandra Cointreau Solid Waste Management Adviser FEU World Bank James Listorti Consultant FEU World Bank Richard Seifman Consultant AFTHV World Bank and Kate Tulenko Public Health Specialist WSP World Bank

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The team would also like to thank Maria Neira Director Jamie Bartram Carlos Corvalán and Annette Prüss Üstün from the World Health Organization Department of Public Health and Environment for sharing data relating to their new estimates of burden of disease from water sanitation and hygiene

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The support of the Bank Netherlands Partnership Program in the preparation of this book is also gratefully acknowledged

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xi Abbreviations and Acronyms AF AIDS ALRI ARI DALY DDT DHS GDP HAZ HIV IAP IMCI ITN IUGR LSMS MAL MDG MICS NGO NISP RR SD UNICEF WAZ WHO WRM WSH WTP attributable fraction acquired immune deficiency syndrome acute lower respiratory infection acute respiratory infection disability adjusted life year dichloro diphenyl trichloroethane Demographic and Health Survey gross domestic product height for age score human immunodeficiency virus indoor air pollution Integrated Management of Childhood Illness strategy insecticide treated net intrauterine growth restriction Living Standards Measurement Survey malnutrition Millennium Development Goals Multiple Indicator Cluster Survey nongovernmental organization National Improved Stove Program China relative risk standard deviation United Nations Children Fund weight for age score World Health Organization water resource management water sanitation and hygiene willingness to pay xiii H P E Introduction INTEREST IN ENVIRONMENTAL HEALTH has mounted in recent years spurred by concern that the most vulnerable groups including children under five years of age are disproportionately exposed to and affected by health risks from environmental hazards see box

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More than percent of the global burden of disease attributed to environmental factors falls on children below five years of age who account for only about percent of the world population WHO

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In large populous areas in South Asia and Sub Saharan Africa where environmental health problems are especially severe malnutrition in young children is also rampant

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Malnutrition is an important contributor to child mortality

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Today in lowincome countries more than million children under the age of five remain chronically undernourished or stunted and more than million are underweight Svedberg World Bank

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Children in the developing world continue to face an onslaught of disease and death from largely preventable factors

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These children are especially susceptible to these environmental factors which put them at risk of developing illness in early life

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Each year approximately million to million malaria infections ENVIRONMENTAL HEALTH AND CHILD SURVIVAL BOX

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What Is Environmental Health

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Environmental health is defined as those health outcomes that are result of environmental risk factors

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The World Health Organization has defined environmental health as all the physical chemical and biological factors external to person and all the related factors impacting behaviours

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health0.191387734041787NN
organization0.0175975629039954NN
environmental0JJ
chemical0.0249430985430622NN
biological0JJ
external0JJ
person0NN
related0.0125195145191824JJ
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behaviour0NN

Label: 12, with a score of: 0.380809341828752
WordScorePoS
world0.00464349782489754NN
health0.0339811641917276NN
organization0NN
environmental0.0598270388037045JJ
chemical0.0332151194779746NN
biological0JJ
external0JJ
person0NN
related0.00833571598658786JJ
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Label: 11, with a score of: 0.356682820684211
WordScorePoS
world0.00626002771693937NN
health0.0229054731708393NN
organization0NN
environmental0.0537696560159885JJ
chemical0NN
biological0JJ
external0JJ
person0.107539312031977NN
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It encompasses the assessment and control of those environmental factors that can potentially affect health

Label: 3, with a score of: 0.654487233249925
WordScorePoS
control0.020806307400253NN
environmental0JJ
potentially0RB
affect0.00625975725959118VB
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Label: 1, with a score of: 0.371824130668404
WordScorePoS
control0.0614198493690006NN
environmental0.0442083771593746JJ
potentially0RB
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Label: 12, with a score of: 0.330996810542191
WordScorePoS
control0NN
environmental0.0598270388037045JJ
potentially0RB
affect0.0166714319731757VB
health0.0339811641917276NN

Label: 5, with a score of: 0.310586095920197
WordScorePoS
control0.0465610847355851NN
environmental0JJ
potentially0RB
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health0.0571058915334038NN

It is targeted towards preventing disease and creating health supportive environments WHO

Label: 3, with a score of: 0.78126917187053
WordScorePoS
target0NN
prevent0VB
disease0.215415047323213NN
create0VB
health0.191387734041787NN
environment0NN

This study incorporates only those environmental health issues that relate to children primarily water sanitation and hygiene indoor air pollution and malaria

Label: 6, with a score of: 0.805690504266018
WordScorePoS
study0NN
environmental0JJ
health0NN
issue0NN
child0.0255958462813622NN
primarily0RB
water0.556409482163189NN
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hygiene0.136665345449673NN
air0NN
pollution0.0590310971343993NN
malaria0NN

Label: 3, with a score of: 0.455203604157212
WordScorePoS
study0NN
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
child0.10682408961305NN
primarily0RB
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
air0.020806307400253NN
pollution0.0175975629039954NN
malaria0.20370424488904NN

Label: 12, with a score of: 0.260418704668764
WordScorePoS
study0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
issue0NN
child0NN
primarily0RB
water0.186896403054502NN
sanitation0NN
hygiene0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
malaria0NN

These problems cause the top three diseases that affect children in developing countries

Label: 3, with a score of: 0.817263713077666
WordScorePoS
disease0.215415047323213NN
affect0.00625975725959118VB
child0.10682408961305NN
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Label: 6, with a score of: 0.372743970090137
WordScorePoS
disease0.103230094596636NN
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child0.0255958462813622NN
develop0VB
country0NN

Sources Breman Alilio and Mills Ezzati Rodgers and others WHO

Label: 6, with a score of: 0.73415387760794
WordScorePoS
source0.0613562156822703NN

lead to more than million deaths of which more than percent occur in African children under five years of age

Label: 3, with a score of: 0.822347340331278
WordScorePoS
lead0.025518364538905NN
death0.193573191943949NN
occur0.0307735781890304VB
african0IN
child0.10682408961305NN
age0.0893142758861673NN

Malnutrition and environmental infections are inextricably linked however over time these links have been forgotten or neglected by policy makers in their formulation of strategies aimed at child survival and development

Label: 3, with a score of: 0.507303530879166
WordScorePoS
malnutrition0NN
environmental0JJ
infection0.122222546933424NN
time0.0127591822694525NN
neglect0.0407408489778079NN
policy0NN
maker0NN
strategy0.0149758277542848NN
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child0.10682408961305NN
development0.00837573444202498NN

Label: 1, with a score of: 0.417125396884093
WordScorePoS
malnutrition0.0736315832425121NN
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infection0NN
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child0.0450489732120807NN
development0.0164833460638534NN

Label: 10, with a score of: 0.40407861455098
WordScorePoS
malnutrition0NN
environmental0.0237821918091848JJ
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strategy0NN
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child0.0242343960710022NN
development0.0177346522508396NN

Label: 8, with a score of: 0.304676650260897
WordScorePoS
malnutrition0NN
environmental0.0295821503613099JJ
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neglect0NN
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child0.0452169560888236NN
development0.0055149369084567NN

Persistent malnutrition and rampant environmental health problems are contributing to the widespread failure among developing countries to meet several of their commitments toward the Millennium Development Goals MDGs including not only the goal to halve poverty and hunger MDG but also the potential to halve maternal and child mortality MDGs and to achieve universal primary education MDG to promote gender equality MDG and to combat malaria and confront the HIV AIDS pandemic MDG by see table

Label: 3, with a score of: 0.751253784646504
WordScorePoS
persistent0.0307735781890304JJ
malnutrition0NN
environmental0JJ
health0.191387734041787NN
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halve0.0249430985430622VB
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maternal0.184641469134183JJ
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malaria0.20370424488904NN
hiv0.448149338755887NN
aid0.123094312756122NN

Label: 5, with a score of: 0.325429299186646
WordScorePoS
persistent0JJ
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millennium0.0911713013253052JJ
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achieve0.0258977780207001VB
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combat0NN
malaria0NN
hiv0NN
aid0NN

Label: 4, with a score of: 0.301625670089255
WordScorePoS
persistent0JJ
malnutrition0NN
environmental0JJ
health0NN
contribute0VB
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combat0NN
malaria0NN
hiv0NN
aid0NN

Label: 1, with a score of: 0.289820952204269
WordScorePoS
persistent0JJ
malnutrition0.0736315832425121NN
environmental0.0442083771593746JJ
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achieve0.0113874611101829VB
universal0JJ
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combat0NN
malaria0NN
hiv0NN
aid0NN

Label: 2, with a score of: 0.213298659353304
WordScorePoS
persistent0JJ
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poverty0.0261926252110933NN
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potential0NN
maternal0JJ
child0.0546336178945768NN
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achieve0.0110482109530745VB
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hiv0NN
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Research indicates that globally under five mortality has fallen from per live births in to per in

Label: 3, with a score of: 0.922820295293185
WordScorePoS
research0.0175975629039954NN
globally0RB
mortality0.276962203701274NN
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birth0.0748292956291867NN

It is expected that the under five death rate for the world will fall by percent from to substantially less than the MDG target of percent decrease Murray and others

Label: 3, with a score of: 0.794562103546581
WordScorePoS
expect0VB
death0.193573191943949NN
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Label: 2, with a score of: 0.371443100357198
WordScorePoS
expect0.0357189919948307VB
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rate0.0155217067874935NN
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Environmental health can contribute to many of the MDGs as is shown in table

Label: 3, with a score of: 0.638916417164406
WordScorePoS
environmental0JJ
health0.191387734041787NN
contribute0VB

Label: 12, with a score of: 0.498149872317398
WordScorePoS
environmental0.0598270388037045JJ
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contribute0.0554128417527413VB

Label: 14, with a score of: 0.32770954890704
WordScorePoS
environmental0JJ
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contribute0.0815049608642826VB

In many developing countries programs to improve child health have focused on improved feeding practices micronutrient supplementation national immunization campaigns and measures to strengthen health systems such measures include improving the availability of drugs ensuring better treatment of cases and hiring more trained personnel

Label: 3, with a score of: 0.593123913685118
WordScorePoS
develop0VB
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child0.10682408961305NN
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drug0.0407408489778079NN
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However with continued exposure to contaminated water inadequate sanitation smoke and dust and mosquitoes children in developing countries are still falling sick problem that imposes sustained and heavy burden on the health system

Label: 6, with a score of: 0.810390509614197
WordScorePoS
continue0VB
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contaminate0.0683326727248364VB
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Label: 3, with a score of: 0.367415684635248
WordScorePoS
continue0VB
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water0.0382775468083574NN
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Label: 12, with a score of: 0.1826132563318
WordScorePoS
continue0.0199423462679015VB
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health0.0339811641917276NN
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And with the recognition of the environment INTRODUCTION TABLE

Label: 12, with a score of: 0.648937606898248
WordScorePoS
environment0.079769385071606NN
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Label: 8, with a score of: 0.481311717399857
WordScorePoS
environment0.0591643007226199NN
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Label: 15, with a score of: 0.420864866502309
WordScorePoS
environment0NN
introduction0.0517339898971162NN

Millennium Development Goals and Environmental Health Millennium Development Goal Environmental Health Determinants Relating to Child Health

Label: 3, with a score of: 0.71072423551408
WordScorePoS
millennium0JJ
development0.00837573444202498NN
goal0NN
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child0.10682408961305NN

Label: 5, with a score of: 0.403091756987033
WordScorePoS
millennium0.0911713013253052JJ
development0.0124956749436837NN
goal0NN
environmental0JJ
health0.0571058915334038NN
child0.0170753354211044NN

To eradicate extreme poverty and hunger Expenses incurred for informal sector delivery of

Label: 1, with a score of: 0.857789794807253
WordScorePoS
eradicate0.0614198493690006VB
extreme0.294526332970048JJ
poverty0.269969049497485NN
hunger0.0736315832425121NN
incur0VB
sector0NN

Label: 2, with a score of: 0.404913393275261
WordScorePoS
eradicate0VB
extreme0.0714379839896614JJ
poverty0.0261926252110933NN
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sector0.0182713919265625NN

To achieve universal primary education

Label: 4, with a score of: 0.858111219168112
WordScorePoS
achieve0.0308700730580309VB
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primary0.108423939529757JJ
education0.244244978014045NN

Label: 5, with a score of: 0.415593107621362
WordScorePoS
achieve0.0258977780207001VB
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To promote gender equality and empower women

Label: 5, with a score of: 0.883234863941309
WordScorePoS
promote0.00624783747184187VB
gender0.196902218579822NN
equality0.18624433894234NN
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woman0.221979360474357NN

Label: 4, with a score of: 0.345648317334512
WordScorePoS
promote0.0111711050494158VB
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To reduce child mortality

Label: 3, with a score of: 0.898756658896401
WordScorePoS
reduce0.01675146888405VB
child0.10682408961305NN
mortality0.276962203701274NN

To improve maternal health

Label: 3, with a score of: 0.922917011650748
WordScorePoS
improve0VB
maternal0.184641469134183JJ
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To combat HIV AIDS malaria and other diseases

Label: 3, with a score of: 0.981754046419646
WordScorePoS
combat0.020806307400253NN
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aid0.123094312756122NN
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disease0.215415047323213NN

To ensure environmental sustainability

Label: 12, with a score of: 0.653322058442046
WordScorePoS
ensure0.00743561777158133VB
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sustainability0.0409791940864438NN

Label: 1, with a score of: 0.416065579639446
WordScorePoS
ensure0.0247250190957801VB
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sustainability0NN

Label: 11, with a score of: 0.354792578968966
WordScorePoS
ensure0.00501208088147356VB
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To establish global partnership for development Source Compiled by World Bank team

Label: 17, with a score of: 0.929730790944646
WordScorePoS
establish0.048933054487825VB
global0.0201198688839505JJ
partnership0.3914644359026NN
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source0.0109843026967392NN
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bank0.036961556179878NN

water and sanitation services as well as costs of medical treatment impose burden on family budgets including food budgets

Label: 6, with a score of: 0.838133512195123
WordScorePoS
water0.556409482163189NN
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food0.0214003646985842NN

Label: 12, with a score of: 0.345314060829489
WordScorePoS
water0.186896403054502NN
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food0.186896403054502NN

Label: 2, with a score of: 0.321948629119875
WordScorePoS
water0NN
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treatment0NN
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include0VB
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Lack of adequate water and sanitation services leads to diarrhea

Label: 6, with a score of: 0.907781452653018
WordScorePoS
lack0.0214003646985842NN
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lead0NN

Label: 12, with a score of: 0.223494304521802
WordScorePoS
lack0NN
adequate0.0234335422829798JJ
water0.186896403054502NN
sanitation0NN
service0.00666957305782837NN
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These problems affect children nutritional status adversely and indirectly add to vicious cycle of poverty

Label: 1, with a score of: 0.666380831657616
WordScorePoS
affect0.0184786920895884VB
child0.0450489732120807NN
nutritional0JJ
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indirectly0RB
add0VB
cycle0NN
poverty0.269969049497485NN

Label: 8, with a score of: 0.3955436471313
WordScorePoS
affect0VB
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nutritional0JJ
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indirectly0RB
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cycle0NN
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In urban areas time spent fetching or queuing for water limits earning capacity

Label: 6, with a score of: 0.787418470786121
WordScorePoS
urban0JJ
time0NN
water0.556409482163189NN
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capacity0.0104991907358033NN

Label: 11, with a score of: 0.462907853595175
WordScorePoS
urban0.27622591898666JJ
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Label: 12, with a score of: 0.294770714903376
WordScorePoS
urban0JJ
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The environmental health burden has significant effects on school performance and attendance

Label: 4, with a score of: 0.469985211027097
WordScorePoS
environmental0JJ
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school0.208127520578185NN
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Label: 3, with a score of: 0.460996370285523
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.382822506391604
WordScorePoS
environmental0.0237821918091848JJ
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performance0.064698038783335NN

Label: 5, with a score of: 0.339238975976282
WordScorePoS
environmental0JJ
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Women disproportionately suffer from exposure to smoke from use of biomass for cooking drudgery and inconvenience from poor access to water and privacy and dignity issues related to inadequate sanitation

Label: 6, with a score of: 0.865382228831662
WordScorePoS
woman0.0127979231406811NN
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related0.0524959536790166JJ
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sanitation0.334686906581616NN

Label: 1, with a score of: 0.310040318714309
WordScorePoS
woman0.0450489732120807NN
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privacy0NN
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related0.0184786920895884JJ
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sanitation0NN

Label: 5, with a score of: 0.214281474561053
WordScorePoS
woman0.221979360474357NN
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access0.00780347258345989NN
water0NN
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related0JJ
inadequate0JJ
sanitation0NN

Label: 12, with a score of: 0.173716489447343
WordScorePoS
woman0NN
suffer0VB
exposure0NN
cooking0NN
poor0.0339811641917276JJ
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water0.186896403054502NN
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issue0NN
related0.00833571598658786JJ
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sanitation0NN

Time spent collecting water and firewood impinges on time to care for sick children or to seek livelihood opportunities

Label: 6, with a score of: 0.741885412996672
WordScorePoS
time0NN
water0.556409482163189NN
care0NN
child0.0255958462813622NN
seek0VB
livelihood0.0295155485671997NN
opportunity0.0153390539205676NN

Label: 12, with a score of: 0.261407432685088
WordScorePoS
time0.0169905820958638NN
water0.186896403054502NN
care0NN
child0NN
seek0VB
livelihood0NN
opportunity0NN

Label: 3, with a score of: 0.325048642633367
WordScorePoS
time0.0127591822694525NN
water0.0382775468083574NN
care0.104031537001265NN
child0.10682408961305NN
seek0VB
livelihood0NN
opportunity0NN

Leading causes of child mortality include diarrhea acute respiratory infections and malaria

Label: 3, with a score of: 0.966938713150029
WordScorePoS
lead0.025518364538905NN
child0.10682408961305NN
mortality0.276962203701274NN
include0VB
infection0.122222546933424NN
malaria0.20370424488904NN

Indoor air pollution adversely affects young children exposure to smoke from biomass use

Label: 1, with a score of: 0.520290610179626
WordScorePoS
air0NN
pollution0NN
affect0.0184786920895884VB
child0.0450489732120807NN
exposure0.120266261535276NN

Label: 3, with a score of: 0.428837003273817
WordScorePoS
air0.020806307400253NN
pollution0.0175975629039954NN
affect0.00625975725959118VB
child0.10682408961305NN
exposure0NN

Label: 11, with a score of: 0.304532457970472
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN
affect0.0112376090361851VB
child0.0273960270556257NN
exposure0NN

Sickness and deaths result from inadequate hygiene water supply and sanitation

Label: 6, with a score of: 0.94969835989593
WordScorePoS
death0.0295155485671997NN
result0.0683326727248364NN
inadequate0.0836717266454039JJ
hygiene0.136665345449673NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN

Label: 12, with a score of: 0.192586246438911
WordScorePoS
death0NN
result0NN
inadequate0JJ
hygiene0NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN

Label: 3, with a score of: 0.192284340343767
WordScorePoS
death0.193573191943949NN
result0NN
inadequate0JJ
hygiene0NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN

Inadequate hygiene and lack of availability of clean water results in poor health outcomes related to delivery and birthing

Label: 6, with a score of: 0.856987897261078
WordScorePoS
inadequate0.0836717266454039JJ
hygiene0.136665345449673NN
lack0.0214003646985842NN
availability0NN
clean0.0348974218717993JJ
water0.556409482163189NN
result0.0683326727248364NN
poor0.0642010940957526JJ
health0NN
outcome0NN
related0.0524959536790166JJ

Label: 1, with a score of: 0.267767812626325
WordScorePoS
inadequate0.0736315832425121JJ
hygiene0NN
lack0.0753297582301286NN
availability0NN
clean0JJ
water0NN
result0NN
poor0.150659516460257JJ
health0NN
outcome0NN
related0.0184786920895884JJ

Label: 12, with a score of: 0.221550145158278
WordScorePoS
inadequate0JJ
hygiene0NN
lack0NN
availability0NN
clean0JJ
water0.186896403054502NN
result0NN
poor0.0339811641917276JJ
health0.0339811641917276NN
outcome0NN
related0.00833571598658786JJ

Label: 3, with a score of: 0.221378974990117
WordScorePoS
inadequate0JJ
hygiene0NN
lack0NN
availability0NN
clean0.020806307400253JJ
water0.0382775468083574NN
result0NN
poor0JJ
health0.191387734041787NN
outcome0NN
related0.0125195145191824JJ

Label: 7, with a score of: 0.137519865856579
WordScorePoS
inadequate0JJ
hygiene0NN
lack0.0383371018038178NN
availability0NN
clean0.125032076213024JJ
water0NN
result0NN
poor0JJ
health0NN
outcome0NN
related0JJ

Malaria and helminths affect pregnant women and can lead to malnutrition of the fetus

Label: 3, with a score of: 0.609652969742497
WordScorePoS
malaria0.20370424488904NN
affect0.00625975725959118VB
pregnant0JJ
woman0.0381514605760894NN
lead0.025518364538905NN
malnutrition0NN

Label: 5, with a score of: 0.494567421316488
WordScorePoS
malaria0NN
affect0VB
pregnant0JJ
woman0.221979360474357NN
lead0NN
malnutrition0NN

Label: 2, with a score of: 0.331289121190389
WordScorePoS
malaria0NN
affect0VB
pregnant0.0583416713841148JJ
woman0.0546336178945768NN
lead0NN
malnutrition0.0357189919948307NN

Label: 1, with a score of: 0.305589203055835
WordScorePoS
malaria0NN
affect0.0184786920895884VB
pregnant0JJ
woman0.0450489732120807NN
lead0NN
malnutrition0.0736315832425121NN

HIV infected children especially need clean environments

Label: 3, with a score of: 0.923133744716184
WordScorePoS
hiv0.448149338755887NN
infected0.0407408489778079JJ
child0.10682408961305NN
clean0.020806307400253JJ
environment0NN

Label: 7, with a score of: 0.187214071321777
WordScorePoS
hiv0NN
infected0JJ
child0NN
clean0.125032076213024JJ
environment0NN

Environmental conditions related to mosquito breeding such as lack of irrigation poor drainage and stagnant water point to the need for adequate water resource management practices

Label: 6, with a score of: 0.810599241178414
WordScorePoS
environmental0JJ
condition0NN
related0.0524959536790166JJ
breed0NN
lack0.0214003646985842NN
irrigation0.0516150472983178NN
poor0.0642010940957526JJ
water0.556409482163189NN
adequate0.0295155485671997JJ
resource0.0104991907358033NN
management0.0428007293971684NN
practice0NN

Label: 12, with a score of: 0.40157611950941
WordScorePoS
environmental0.0598270388037045JJ
condition0.0409791940864438NN
related0.00833571598658786JJ
breed0NN
lack0NN
irrigation0NN
poor0.0339811641917276JJ
water0.186896403054502NN
adequate0.0234335422829798JJ
resource0.0416785799329393NN
management0.0339811641917276NN
practice0.0703006268489394NN

Label: 1, with a score of: 0.242556461856745
WordScorePoS
environmental0.0442083771593746JJ
condition0NN
related0.0184786920895884JJ
breed0NN
lack0.0753297582301286NN
irrigation0NN
poor0.150659516460257JJ
water0NN
adequate0.0519476926891779JJ
resource0.0739147683583536NN
management0NN
practice0NN

Access to water and sanitation is goal in itself

Label: 6, with a score of: 0.96435487289434
WordScorePoS
access0.00731085509381114NN
water0.556409482163189NN
sanitation0.334686906581616NN
goal0NN

Label: 12, with a score of: 0.203107719957531
WordScorePoS
access0.00232174891244877NN
water0.186896403054502NN
sanitation0NN
goal0NN

Slum dwellers including children face dismal living conditions congested settlements and poor access to environmental services

Label: 11, with a score of: 0.640180777634025
WordScorePoS
slum0.146277152173395NN
include0VB
child0.0273960270556257NN
live0.0269743071558856VB
condition0NN
settlement0.146277152173395NN
poor0.0229054731708393JJ
access0.00626002771693937NN
environmental0.0537696560159885JJ
service0.0269743071558856NN

Label: 1, with a score of: 0.50917073317956
WordScorePoS
slum0NN
include0VB
child0.0450489732120807NN
live0.0739258553811849VB
condition0NN
settlement0NN
poor0.150659516460257JJ
access0.00514687440545096NN
environmental0.0442083771593746JJ
service0.0443555132287109NN

Label: 8, with a score of: 0.321607256254365
WordScorePoS
slum0NN
include0VB
child0.0452169560888236NN
live0.00989353561471291VB
condition0.121575732851624NN
settlement0NN
poor0JJ
access0.00344404437204141NN
environmental0.0295821503613099JJ
service0.0197870712294258NN

Multisectoral coordination on environmental health issues is lacking

Label: 3, with a score of: 0.614153845496635
WordScorePoS
coordination0NN
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
lack0NN

Label: 17, with a score of: 0.362889024632423
WordScorePoS
coordination0.0978661089756501NN
environmental0JJ
health0NN
issue0.0299586785922821NN
lack0NN

Label: 1, with a score of: 0.339363578717638
WordScorePoS
coordination0NN
environmental0.0442083771593746JJ
health0NN
issue0NN
lack0.0753297582301286NN

Label: 9, with a score of: 0.330458718881434
WordScorePoS
coordination0NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
issue0NN
lack0.0565629593551219NN

Both horizontal and vertical links are needed

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL contribution to malnutrition there is an urgent need to broaden the spectrum of interventions beyond the health sector

Label: 3, with a score of: 0.739118393298977
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
contribution0NN
malnutrition0NN
urgent0JJ
broaden0VB
intervention0.0407408489778079NN
sector0NN

Objectives The World Bank study titled Repositioning Nutrition as Central to Development placed nutrition as central issue to achieving the MDGs and established that malnutrition is not only due to lack of food but also the result of environmental risk factors

Label: 2, with a score of: 0.783717618942383
WordScorePoS
objective0NN
world0.0124838525528648NN
bank0.0881366997038154NN
study0NN
nutrition0.175025014152344NN
central0.0440683498519077JJ
development0.0159922815774215NN
issue0NN
achieve0.0110482109530745VB
establish0VB
malnutrition0.0357189919948307NN
due0JJ
lack0NN
food0.292342270824999NN
result0NN
environmental0JJ
risk0.0252000451111224NN

Label: 12, with a score of: 0.266481776121697
WordScorePoS
objective0NN
world0.00464349782489754NN
bank0NN
study0NN
nutrition0NN
central0JJ
development0.022306853314744NN
issue0NN
achieve0.0154106104202498VB
establish0VB
malnutrition0NN
due0.0234335422829798JJ
lack0NN
food0.186896403054502NN
result0NN
environmental0.0598270388037045JJ
risk0NN

This report complements that study by looking at environmental health issues that affect child health broadly while also exploring the links through malnutrition

Label: 3, with a score of: 0.776117035760868
WordScorePoS
report0.0307735781890304NN
complement0NN
study0NN
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
affect0.00625975725959118VB
child0.10682408961305NN
malnutrition0NN

This report argues that environmental health interventions are preventive measures that are imperative to improve child survival with sustainable results in the long term

Label: 3, with a score of: 0.60404468309313
WordScorePoS
report0.0307735781890304NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
measure0NN
improve0VB
child0.10682408961305NN
sustainable0.00087176582269799JJ
result0NN
term0NN

Label: 17, with a score of: 0.292799045410943
WordScorePoS
report0NN
environmental0JJ
health0NN
intervention0NN
measure0NN
improve0.0183291958415182VB
child0NN
sustainable0.0115176738164035JJ
result0NN
term0.149793392961411NN

Label: 1, with a score of: 0.323212267184552
WordScorePoS
report0NN
environmental0.0442083771593746JJ
health0NN
intervention0NN
measure0.103895385378356NN
improve0VB
child0.0450489732120807NN
sustainable0.00514687440545096JJ
result0NN
term0NN

Preventive measures such as improving environmental conditions are effective in reducing child exposure to disease agent and thereby averting infection Murphy Stanton and Galbraith

Label: 3, with a score of: 0.691674428515946
WordScorePoS
measure0NN
improve0VB
environmental0JJ
condition0NN
effective0.00914534810831654JJ
reduce0.01675146888405VB
child0.10682408961305NN
exposure0NN
disease0.215415047323213NN
avert0.0814816979556159VB
infection0.122222546933424NN

Label: 1, with a score of: 0.413498355666806
WordScorePoS
measure0.103895385378356NN
improve0VB
environmental0.0442083771593746JJ
condition0NN
effective0JJ
reduce0.0164833460638534VB
child0.0450489732120807NN
exposure0.120266261535276NN
disease0NN
avert0VB
infection0NN

Label: 8, with a score of: 0.338151360939024
WordScorePoS
measure0.0347609334428716NN
improve0.0150723186962745VB
environmental0.0295821503613099JJ
condition0.121575732851624NN
effective0.0180650490434051JJ
reduce0.0055149369084567VB
child0.0452169560888236NN
exposure0NN
disease0NN
avert0VB
infection0NN

The overall aim of this report is to provide information to decision makers on the optimal design of policies to help reduce premature deaths and illness in children under five years of age

Label: 3, with a score of: 0.670477531366922
WordScorePoS
aim0.020806307400253NN
report0.0307735781890304NN
provide0.0100171139310145VB
information0.00914534810831654NN
decision0NN
maker0NN
policy0NN
reduce0.01675146888405VB
premature0.0407408489778079JJ
death0.193573191943949NN
illness0.0407408489778079NN
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.361341345261479
WordScorePoS
aim0NN
report0NN
provide0.0295703421524739VB
information0NN
decision0.0519476926891779NN
maker0NN
policy0.0450489732120807NN
reduce0.0164833460638534VB
premature0JJ
death0NN
illness0NN
child0.0450489732120807NN
age0.112994637345193NN

To protect the health development and wellbeing of young children decision makers must identify and reduce environmental risk factors by providing appropriate interventions that prevent and diminish exposures

Label: 3, with a score of: 0.53468346539921
WordScorePoS
protect0.00914534810831654VB
health0.191387734041787NN
development0.00837573444202498NN
child0.10682408961305NN
decision0NN
maker0NN
identify0VB
reduce0.01675146888405VB
environmental0JJ
risk0.0703902516159815NN
provide0.0100171139310145VB
intervention0.0407408489778079NN
prevent0VB
diminish0VB
exposure0NN

Label: 1, with a score of: 0.443128378333852
WordScorePoS
protect0VB
health0NN
development0.0164833460638534NN
child0.0450489732120807NN
decision0.0519476926891779NN
maker0NN
identify0VB
reduce0.0164833460638534VB
environmental0.0442083771593746JJ
risk0.0519476926891779NN
provide0.0295703421524739VB
intervention0NN
prevent0VB
diminish0VB
exposure0.120266261535276NN

Label: 16, with a score of: 0.304089466760955
WordScorePoS
protect0.0241291244414115VB
health0NN
development0.0368309542451156NN
child0.0603953832457135NN
decision0.0464294830712827NN
maker0NN
identify0VB
reduce0.0220985725470694VB
environmental0JJ
risk0NN
provide0.013214597504793VB
intervention0NN
prevent0.0548954478802642VB
diminish0VB
exposure0NN

Label: 11, with a score of: 0.303079259178852
WordScorePoS
protect0.0328357290160445VB
health0.0229054731708393NN
development0.0100241617629471NN
child0.0273960270556257NN
decision0NN
maker0NN
identify0VB
reduce0.0200483235258943VB
environmental0.0537696560159885JJ
risk0.0631828116343571NN
provide0.0269743071558856VB
intervention0NN
prevent0VB
diminish0VB
exposure0NN

This study is intended to advance the understanding of what those risk factors are when and how to reduce children exposure to them and how to mitigate their consequent health impact

Label: 3, with a score of: 0.657715089869591
WordScorePoS
study0NN
advance0NN
risk0.0703902516159815NN
reduce0.01675146888405VB
child0.10682408961305NN
exposure0NN
health0.191387734041787NN
impact0NN

Label: 1, with a score of: 0.398954294345879
WordScorePoS
study0NN
advance0NN
risk0.0519476926891779NN
reduce0.0164833460638534VB
child0.0450489732120807NN
exposure0.120266261535276NN
health0NN
impact0NN

Label: 11, with a score of: 0.324874004357975
WordScorePoS
study0NN
advance0.0373517915079663NN
risk0.0631828116343571NN
reduce0.0200483235258943VB
child0.0273960270556257NN
exposure0NN
health0.0229054731708393NN
impact0.0194583992186006NN

Accordingly the study has the following objectives â–  To provide an improved understanding of the links between environmental health risks and malnutrition through review of literature and research

Label: 3, with a score of: 0.511776091187244
WordScorePoS
study0NN
objective0NN
provide0.0100171139310145VB
improve0VB
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
malnutrition0NN
review0NN
research0.0175975629039954NN

Label: 9, with a score of: 0.368039551813032
WordScorePoS
study0NN
objective0.0368585655748969NN
provide0.00740117451847634VB
improve0VB
environmental0.0221298700466866JJ
health0.0377086395700813NN
risk0NN
malnutrition0NN
review0NN
research0.104016094894625NN

Label: 1, with a score of: 0.352554396762597
WordScorePoS
study0NN
objective0NN
provide0.0295703421524739VB
improve0VB
environmental0.0442083771593746JJ
health0NN
risk0.0519476926891779NN
malnutrition0.0736315832425121NN
review0NN
research0NN

Label: 11, with a score of: 0.343482749486624
WordScorePoS
study0NN
objective0NN
provide0.0269743071558856VB
improve0.0273960270556257VB
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
malnutrition0NN
review0NN
research0NN

Moreover the study discusses the role of environmental health inputs in child survival and growth

Label: 3, with a score of: 0.550012043354419
WordScorePoS
study0NN
environmental0JJ
health0.191387734041787NN
input0NN
child0.10682408961305NN
growth0NN

Label: 8, with a score of: 0.52262851170864
WordScorePoS
study0NN
environmental0.0295821503613099JJ
health0NN
input0NN
child0.0452169560888236NN
growth0.208565600657229NN

Label: 10, with a score of: 0.369469437728619
WordScorePoS
study0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
input0NN
child0.0242343960710022NN
growth0.11178243319132NN

â–  To analyze new data for the environmental health burden of disease at subregional level that relates to children under five

Label: 3, with a score of: 0.810103199448218
WordScorePoS
datum0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
level0NN
child0.10682408961305NN

These data which are from World Health Organization WHO report Fewtrell and others include the total effects of environmental risk factors on health outcomes including those mediated through malnutrition

Label: 3, with a score of: 0.689467864217627
WordScorePoS
datum0NN
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
report0.0307735781890304NN
include0VB
total0NN
effect0NN
environmental0JJ
risk0.0703902516159815NN
outcome0NN
malnutrition0NN

Label: 9, with a score of: 0.340092031665379
WordScorePoS
datum0.0454743001434393NN
world0.00257642711761688NN
health0.0377086395700813NN
organization0NN
report0NN
include0VB
total0.0260040237236563NN
effect0.0454743001434393NN
environmental0.0221298700466866JJ
risk0NN
outcome0.030745604615229NN
malnutrition0NN

Label: 12, with a score of: 0.302294552020745
WordScorePoS
datum0NN
world0.00464349782489754NN
health0.0339811641917276NN
organization0NN
report0.0409791940864438NN
include0VB
total0.0468670845659596NN
effect0NN
environmental0.0598270388037045JJ
risk0NN
outcome0NN
malnutrition0NN

Using two country examples the study calculates the associated economic costs including the costs of cognitive and learning impacts and of future work productivity

Label: 4, with a score of: 0.449989407532788
WordScorePoS
country0NN
study0NN
economic0JJ
cost0NN
include0VB
learn0.244520809605025VB
impact0NN
future0NN
productivity0NN

Label: 8, with a score of: 0.312045371539832
WordScorePoS
country0NN
study0NN
economic0.128463821595706JJ
cost0NN
include0VB
learn0VB
impact0NN
future0NN
productivity0.0410992516792148NN

Label: 10, with a score of: 0.433281243907969
WordScorePoS
country0NN
study0NN
economic0.103276847978089JJ
cost0.0660824365173543NN
include0VB
learn0VB
impact0NN
future0NN
productivity0NN

Label: 12, with a score of: 0.392022605179999
WordScorePoS
country0NN
study0NN
economic0.0433009429988926JJ
cost0.0277064208763707NN
include0VB
learn0VB
impact0.0866018859977851NN
future0.0277064208763707NN
productivity0NN

â–  To highlight through illustrative examples how environmental health interventions are being delivered in developing countries through variety of health infrastructure and environmental programs

Label: 3, with a score of: 0.617014005485858
WordScorePoS
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
deliver0VB
develop0VB
country0NN
variety0NN
infrastructure0NN

Label: 9, with a score of: 0.454372773905221
WordScorePoS
environmental0.0221298700466866JJ
health0.0377086395700813NN
intervention0NN
deliver0VB
develop0VB
country0NN
variety0NN
infrastructure0.192202909044225NN

Label: 12, with a score of: 0.363782133960752
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
deliver0.0332151194779746VB
develop0VB
country0NN
variety0NN
infrastructure0.028867295332595NN

Label: 1, with a score of: 0.304026877600324
WordScorePoS
environmental0.0442083771593746JJ
health0NN
intervention0NN
deliver0VB
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The study also discusses the institutional and governance implications of delivering such multisectoral interventions

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INTRODUCTION Audience The main audience for this report is senior policy makers and their technical staffs who work in the ministries of planning finance health environment rural development and infrastructure in developing countries and who are involved in designing policies for and allocating resources to programs that contribute toward improving child health

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The study will also be useful to state and locallevel governments because the actual implementation of programs and initiatives on child health is at the level of communities and households

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Furthermore donors and other organizations financing child health improvement initiatives and projects will benefit from discussion of how interventions addressing environmental risks are important complements to health sector programs such as micronutrient supplementation and vaccination campaigns

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Finally health environment and infrastructure specialists working in developing countries will also gain from understanding the importance of working on children health from different angles in harmonized constructive and collaborative way

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Primer on Environmental Health Environmental health relates to human activity or environmental factors that have an impact on socioeconomic and environmental conditions with the potential to reduce human disease injury and death especially among vulnerable groups mainly the poor women and children under five Listorti and Doumani Lvovsky

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The top killers of children under five are acute respiratory infections from indoor air pollution diarrheal diseases mostly from poor water sanitation and hygiene and malaria from inadequate environmental management and vector control

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This report concentrates on three specific environmental risk factors that influence child health poor water sanitation and hygiene indoor air pollution and inadequate malaria vector control

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Poor Water and Sanitation Access With

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billion people lacking access to safe drinking water and

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billion without adequate sanitation the magnitude of the water and sanitation problem remains significant WHO and UNICEF

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Each year contaminated water and poor sanitation contribute to

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billion cases of diarrhea worldwide and

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million deaths mostly among children under the age of five Hutton and Haller

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Intestinal worms which thrive in poor sanitary conditions infect close to percent of children in the developing world and depending on the severity of the infection may lead to malnutrition anemia or retarded growth which in turn leads to diminished school performance see Hotez and others UNICEF

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About million people are blind from trachoma disease caused by the lack of water combined with poor hygiene practices

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Indoor Air Pollution Indoor air pollution much less publicized source of poor health is responsible for more than

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million deaths per year and for

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percent of global burden of disease Smith Mehta and Maeusezahl Feuz WHO

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It is estimated that half of the world population mainly in developing countries uses solid fuels biomass and coal for household cooking and space heating Rehfuess Mehta and Prüss Üstün

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Cooking and heating with such solid fuels on open fires or stoves without chimneys lead to indoor air pollution which in turn results in respiratory infections

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Exposure to these health damaging pollutants is particularly high among women and children in developing countries who spend the most time inside the household

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As many as half of the deaths attributable to indoor use of solid fuel are of children under the age of five Smith Mehta and Maeusezahl Feuz

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Malaria Approximately percent of the world people mostly those living in the world poorest countries are at risk from malaria

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Every year more than million people become severely ill with malaria with most cases and deaths found in SubSaharan Africa

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However Asia Latin America the Middle East and parts of Europe are also affected

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Pregnant women are especially at high risk of malaria

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Nonimmune pregnant women risk both acute and severe clinical disease resulting in fetal loss in up to percent of such women and maternal deaths in more than percent including percent mortality rate for those with severe disease

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pregnant0JJ
woman0.221979360474357NN
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disease0NN
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loss0NN
maternal0JJ
death0NN
include0VB
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Semi immune pregnant women with malaria infection risk severe anemia and impaired fetal growth even if they show no signs of acute clinical disease

Label: 3, with a score of: 0.818723002669745
WordScorePoS
pregnant0JJ
woman0.0381514605760894NN
malaria0.20370424488904NN
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disease0.215415047323213NN

Label: 8, with a score of: 0.319715149670483
WordScorePoS
pregnant0JJ
woman0.0452169560888236NN
malaria0NN
infection0NN
risk0NN
growth0.208565600657229NN
disease0NN

Label: 5, with a score of: 0.279649497458699
WordScorePoS
pregnant0JJ
woman0.221979360474357NN
malaria0NN
infection0NN
risk0NN
growth0NN
disease0NN

An estimated women and infants die annually as result of malaria infection during pregnancy WHO

Label: 3, with a score of: 0.827271272597856
WordScorePoS
estimate0.059903311017139NN
woman0.0381514605760894NN
infant0NN
die0.0748292956291867VB
annually0RB
result0NN
malaria0.20370424488904NN
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Label: 5, with a score of: 0.368149860212963
WordScorePoS
estimate0NN
woman0.221979360474357NN
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die0VB
annually0RB
result0NN
malaria0NN
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Primer on Malnutrition Malnutrition remains an underlying cause of death in half of the

Label: 3, with a score of: 0.631438431900075
WordScorePoS
malnutrition0NN
remains0NNS
underlie0VB
death0.193573191943949NN

Label: 1, with a score of: 0.480374487748638
WordScorePoS
malnutrition0.0736315832425121NN
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underlie0VB
death0NN

Label: 6, with a score of: 0.369218458679876
WordScorePoS
malnutrition0.041835863322702NN
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death0.0295155485671997NN

Label: 2, with a score of: 0.315234588759491
WordScorePoS
malnutrition0.0357189919948307NN
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million deaths globally in children under five Bryce and others

Label: 3, with a score of: 0.848570157880169
WordScorePoS
death0.193573191943949NN
globally0RB
child0.10682408961305NN

Label: 16, with a score of: 0.301761697730081
WordScorePoS
death0.0464294830712827NN
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In low income countries more than million or percent children under the age of five remain chronically undernourished or stunted and more than million or percent are underweight

Label: 2, with a score of: 0.668943927916043
WordScorePoS
income0.0643370113878709NN
country0NN
child0.0546336178945768NN
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remain0VB
undernourished0.132205049555723JJ
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Label: 10, with a score of: 0.414502561840863
WordScorePoS
income0.166475342664294NN
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child0.0242343960710022NN
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undernourished0JJ
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Label: 1, with a score of: 0.334556466527801
WordScorePoS
income0.0442083771593746NN
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child0.0450489732120807NN
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Label: 3, with a score of: 0.324443577800028
WordScorePoS
income0NN
country0NN
child0.10682408961305NN
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remain0VB
undernourished0JJ
stunt0NN

South Asia where about one fifth of the world population lives still has both the highest rates and the largest numbers of malnourished children in the world

Label: 2, with a score of: 0.480219330251953
WordScorePoS
south0RB
asia0IN
world0.0124838525528648NN
population0.0310434135749871NN
life0NN
rate0.0155217067874935NN
largest0.0714379839896614JJS
child0.0546336178945768NN

Label: 3, with a score of: 0.430055929767837
WordScorePoS
south0RB
asia0IN
world0.00087176582269799NN
population0NN
life0.0250390290383647NN
rate0.0433561464459019NN
largest0JJS
child0.10682408961305NN

Label: 10, with a score of: 0.323335986361385
WordScorePoS
south0RB
asia0IN
world0.00276879546803864NN
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life0NN
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child0.0242343960710022NN

Label: 1, with a score of: 0.322410056976998
WordScorePoS
south0RB
asia0IN
world0.00257343720272548NN
population0NN
life0.0184786920895884NN
rate0.0639932865717261NN
largest0JJS
child0.0450489732120807NN

In Afghanistan Bangladesh India and Pakistan the prevalence rate varies from to percent and is only gradually declining whereas in Sub Saharan Africa while the rate is lower at percent it is on the rise Svedberg World Bank

Label: 0, with a score of: 1

Although lack of food is obviously an important reason for malnutrition recent reports and studies ever more consistently suggest that much of malnutrition is INTRODUCTION actually caused by bad sanitation and disease especially in young children WHO World Bank

Label: 6, with a score of: 0.634956976264402
WordScorePoS
lack0.0214003646985842NN
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malnutrition0.041835863322702NN
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Label: 2, with a score of: 0.497302394027696
WordScorePoS
lack0NN
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malnutrition0.0357189919948307NN
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bad0JJ
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child0.0546336178945768NN
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Label: 3, with a score of: 0.36296602526314
WordScorePoS
lack0NN
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malnutrition0NN
report0.0307735781890304NN
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world0.00087176582269799NN
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Label: 12, with a score of: 0.222783493775505
WordScorePoS
lack0NN
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malnutrition0NN
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Thus contrary to popular perception in many countries where malnutrition is widespread insufficient food production is often not the determining factor of malnutrition Prüss Üstün and Corvalán World Bank

Label: 2, with a score of: 0.783876486147374
WordScorePoS
country0NN
malnutrition0.0357189919948307NN
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food0.292342270824999NN
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Label: 12, with a score of: 0.468733100994733
WordScorePoS
country0NN
malnutrition0NN
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food0.186896403054502NN
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A recent collective expert opinion stated that about percent of the consequences of malnutrition are in fact caused by inadequate water and sanitation provisions and poor hygienic practices Prüss Üstün and Corvalán thus highlighting the need to mainstream environmental health into the development agenda

Label: 6, with a score of: 0.811874098772742
WordScorePoS
malnutrition0.041835863322702NN
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poor0.0642010940957526JJ
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Label: 12, with a score of: 0.305948638591928
WordScorePoS
malnutrition0NN
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Label: 1, with a score of: 0.269382292089337
WordScorePoS
malnutrition0.0736315832425121NN
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water0NN
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Label: 3, with a score of: 0.216283816520501
WordScorePoS
malnutrition0NN
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Nutrition in early childhood starting from the womb is critical for child health and consequently for adult health

Label: 3, with a score of: 0.722534619729575
WordScorePoS
nutrition0NN
childhood0NN
critical0JJ
child0.10682408961305NN
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Label: 4, with a score of: 0.47349578933756
WordScorePoS
nutrition0NN
childhood0.0815069365350084NN
critical0JJ
child0.076326555629389NN
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Label: 2, with a score of: 0.338922512827222
WordScorePoS
nutrition0.175025014152344NN
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Maternal anemia in pregnant women caused from combination of malaria and hookworm infections leads to malnourishment of the fetus condition called intrauterine growth restriction IUGR

Label: 3, with a score of: 0.703815226628119
WordScorePoS
maternal0.184641469134183JJ
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Label: 8, with a score of: 0.521839588435828
WordScorePoS
maternal0JJ
pregnant0JJ
woman0.0452169560888236NN
cause0NN
malaria0NN
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lead0.0504071033101074NN
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restriction0NN

Label: 5, with a score of: 0.272069125487322
WordScorePoS
maternal0JJ
pregnant0JJ
woman0.221979360474357NN
cause0NN
malaria0NN
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lead0NN
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restriction0NN

Babies suffer from low birth weight in developing countries mostly because of IUGR whereas in developed countries the condition is far more often attributable to preterm birth

Label: 0, with a score of: 1

Repeated infections especially diarrhea and helminths caused by poor environmental conditions lead to underweight low weight for age and stunted low height for age children

Label: 1, with a score of: 0.652127856052015
WordScorePoS
infection0NN
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Label: 3, with a score of: 0.481935999387207
WordScorePoS
infection0.122222546933424NN
cause0NN
poor0JJ
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lead0.025518364538905NN
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Label: 2, with a score of: 0.33288422783761
WordScorePoS
infection0NN
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poor0.0548141757796873JJ
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Label: 8, with a score of: 0.330628419810255
WordScorePoS
infection0NN
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poor0JJ
environmental0.0295821503613099JJ
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lead0.0504071033101074NN
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These growth faltering effects in turn make individuals more predisposed to infections and even to chronic diseases later in life

Label: 3, with a score of: 0.714780651294833
WordScorePoS
growth0NN
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individual0JJ
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Label: 8, with a score of: 0.435420853721631
WordScorePoS
growth0.208565600657229NN
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life0.0123650647908625NN

Label: 10, with a score of: 0.347816259986123
WordScorePoS
growth0.11178243319132NN
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Label: 6, with a score of: 0.338124209522703
WordScorePoS
growth0NN
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chronic0.0683326727248364JJ
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Commonly used indicators of malnutrition are underweight stunting and wasting

Label: 12, with a score of: 0.543944153288201
WordScorePoS
malnutrition0NN
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waste0.138532104381853NN

Label: 2, with a score of: 0.715395112458693
WordScorePoS
malnutrition0.0357189919948307NN
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Underweight is measured as the child weight for age relative to an international reference population

Label: 1, with a score of: 0.557789109591298
WordScorePoS
measure0.103895385378356NN
child0.0450489732120807NN
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Label: 3, with a score of: 0.409365842047639
WordScorePoS
measure0NN
child0.10682408961305NN
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Label: 2, with a score of: 0.371038393127866
WordScorePoS
measure0.0504000902222448NN
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Label: 8, with a score of: 0.316320779315347
WordScorePoS
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Stunting is measured as the child height for age and wasting is measured as the weight for height

Label: 12, with a score of: 0.177817851509648
WordScorePoS
stunt0NN
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child0NN
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Label: 1, with a score of: 0.778323989557025
WordScorePoS
stunt0NN
measure0.103895385378356NN
child0.0450489732120807NN
height0.120266261535276NN
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waste0NN

Label: 2, with a score of: 0.434435995133508
WordScorePoS
stunt0.11668334276823NN
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Underweight is an indicator of chronic or acute malnutrition or combination of both

Label: 6, with a score of: 0.802749062346211
WordScorePoS
chronic0.0683326727248364JJ
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Label: 1, with a score of: 0.536520557752426
WordScorePoS
chronic0JJ
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Stunting is an indicator of chronic malnutrition and wasting an indicator of acute malnutrition

Label: 12, with a score of: 0.40539425830996
WordScorePoS
stunt0NN
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Label: 2, with a score of: 0.637700838621363
WordScorePoS
stunt0.11668334276823NN
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Label: 6, with a score of: 0.444818989919433
WordScorePoS
stunt0NN
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How far child measure is from the mean of the reference population measured in standard deviations SDs from the mean determines the extent of malnutrition mild SD to SD moderate SD to SD or severe greater than SD

Label: 1, with a score of: 0.611568738874889
WordScorePoS
child0.0450489732120807NN
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Childhood malnutrition is associated with increased susceptibility to disease and with poor mental development and learning ability

Label: 4, with a score of: 0.612176156668167
WordScorePoS
childhood0.0815069365350084NN
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Label: 3, with a score of: 0.463554906215826
WordScorePoS
childhood0NN
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Label: 1, with a score of: 0.400143847592318
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childhood0NN
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Label: 6, with a score of: 0.362832163532243
WordScorePoS
childhood0NN
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In the long term those outcomes are significant cost to countries Alderman and others

Label: 17, with a score of: 0.528149949450412
WordScorePoS
term0.149793392961411NN
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Label: 10, with a score of: 0.632039336809876
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Label: 16, with a score of: 0.312247445346105
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term0NN
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Although research and mainstream debate have revolved around how malnourished children are more susceptible to infectious diseases including diarrhea and acute respiratory infections the extent to which environmental risk factors contribute to malnutrition is not widely acknowledged

Label: 3, with a score of: 0.763762250383633
WordScorePoS
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Content and Organization This report is organized into three main sections the first looks at the epidemiology science and research evidence the second presents the economics costs of ENVIRONMENTAL HEALTH AND CHILD SURVIVAL the burden of disease and costs related to learning deficits and productivity losses and the third describes the experiences of environmental health actions in developing countries

Label: 3, with a score of: 0.624310103901169
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Label: 10, with a score of: 0.352816178510318
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Label: 4, with a score of: 0.247769512413118
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Each section strives to present the latest information and data and highlights the reasons environmental health is so critical in the context of child survival and development

Label: 3, with a score of: 0.53055239338108
WordScorePoS
strive0VBP
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Label: 9, with a score of: 0.498800159675883
WordScorePoS
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development0.0330049940546426NN

Label: 17, with a score of: 0.364241947333585
WordScorePoS
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Epidemiology Chapter argues that improvements in environmental health are very important for child survival and development especially considering its links through malnutrition

Label: 3, with a score of: 0.620011131490012
WordScorePoS
improvement0NN
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Label: 1, with a score of: 0.362744042097925
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The epidemiological underpinnings of the infections malnutrition cycle are important because repeated infections cause decrease in dietary intake producing for example malabsorption of nutrients which in effect causes malnutrition thereby making children weak in resisting disease and likely to fall sick again

Label: 3, with a score of: 0.824411111724656
WordScorePoS
infection0.122222546933424NN
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Until recently the impact of diseases such as diarrhea and respiratory infections on malnutrition in children was relatively ignored

Label: 3, with a score of: 0.831119908177665
WordScorePoS
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Label: 6, with a score of: 0.353123833808422
WordScorePoS
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Over the past several decades dozens of studies many of them long term cohort studies have investigated the causal relationship between disease and malnutrition

Label: 3, with a score of: 0.590765029846345
WordScorePoS
decade0NN
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Label: 17, with a score of: 0.410800913693168
WordScorePoS
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Label: 6, with a score of: 0.397836158730918
WordScorePoS
decade0NN
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Label: 13, with a score of: 0.340700796848777
WordScorePoS
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These cohort studies have provided strong evidence of how almost all infections influence child nutritional status

Label: 10, with a score of: 0.643247379874819
WordScorePoS
study0NN
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Label: 3, with a score of: 0.586123271204056
WordScorePoS
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A review of the studies was carried out for this report and served to provide further corroboration of the impacts of environmental infections on child growth including through malnutrition

Label: 8, with a score of: 0.458132331800435
WordScorePoS
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Label: 3, with a score of: 0.436261826148852
WordScorePoS
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Label: 1, with a score of: 0.395147072159639
WordScorePoS
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Label: 12, with a score of: 0.335342960122933
WordScorePoS
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Evidence from several of the studies demonstrates how exposure to environmental health risks in early infancy leads to permanent growth faltering lowered immunity and increased morbidity and mortality

Label: 3, with a score of: 0.694646965096105
WordScorePoS
evidence0NN
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Label: 10, with a score of: 0.428814755097227
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Label: 8, with a score of: 0.354930428051018
WordScorePoS
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Label: 1, with a score of: 0.322163916552226
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Environmental health inputs both at the household and the community levels play critical role in child survival and growth

Label: 3, with a score of: 0.461098303005061
WordScorePoS
environmental0JJ
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Label: 8, with a score of: 0.449923579706226
WordScorePoS
environmental0.0295821503613099JJ
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Label: 10, with a score of: 0.392159937019182
WordScorePoS
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In the life cycle of child environmental health interventions are critical especially in the period from the womb to the age of about two years

Label: 3, with a score of: 0.697529543424108
WordScorePoS
life0.0250390290383647NN
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Label: 12, with a score of: 0.412847227405799
WordScorePoS
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Label: 1, with a score of: 0.339651753843278
WordScorePoS
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This period is the so called window of opportunity

Label: 2, with a score of: 0.615603086860985
WordScorePoS
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Label: 7, with a score of: 0.481518846248757
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Label: 12, with a score of: 0.359045947683902
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Pregnant women in developing countries are often exposed to environmental risks such as malaria and hookworm infections which contribute to poor fetal growth and result in babies with low birth weights

Label: 3, with a score of: 0.608718523814291
WordScorePoS
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Label: 1, with a score of: 0.410928314987782
WordScorePoS
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Label: 8, with a score of: 0.338680721440634
WordScorePoS
pregnant0JJ
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Label: 5, with a score of: 0.26531225683621
WordScorePoS
pregnant0JJ
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Smoky kitchens from use of biomass fuels have anecdotally revealed impacts on low birth weight and perinatal mortality

Label: 3, with a score of: 0.857110363221125
WordScorePoS
fuel0NN
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In early infancy improper feeding practices and poor sanitation have pernicious synergistic effect on the child nutritional status

Label: 6, with a score of: 0.719464685526824
WordScorePoS
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Label: 1, with a score of: 0.331709552638708
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Label: 2, with a score of: 0.401793283617095
WordScorePoS
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Many of these impacts on child growth have also been seen to result in cognition and learning impacts as well as chronic diseases later in life

Label: 3, with a score of: 0.48399464469182
WordScorePoS
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Label: 4, with a score of: 0.464612167395742
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Label: 8, with a score of: 0.370924625105119
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Label: 6, with a score of: 0.42068354233308
WordScorePoS
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Current child survival strategies in developing countries mostly adopt more treatment oriented perspective relying mainly on case management and focusing primarily on reducing mortality

Label: 3, with a score of: 0.718812172241428
WordScorePoS
current0JJ
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Most of these strategies while intended to increase the ability of the host to resist or reduce infection once exposure has occurred do not attempt to reduce the exposure to environmental determinants of ill health

Label: 3, with a score of: 0.628950834340395
WordScorePoS
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Label: 1, with a score of: 0.558922365353391
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Label: 12, with a score of: 0.355148025245585
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INTRODUCTION Chapter explores how appropriate environmental health actions can complement and supplement strategies that focus on child health by adding value to health systems by assisting in the adaptation of environmental management programs and by promoting adjustments to infrastructure strategies

Label: 3, with a score of: 0.60338965994467
WordScorePoS
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Label: 9, with a score of: 0.33141835349961
WordScorePoS
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Label: 11, with a score of: 0.33426062425344
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Economics Chapter provides key information and data relating to the burden of disease from environmental factors and to the associated economic costs

Label: 3, with a score of: 0.426543123955761
WordScorePoS
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Label: 8, with a score of: 0.3002017451814
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Label: 10, with a score of: 0.366864194864331
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Label: 12, with a score of: 0.317910862315563
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Label: 9, with a score of: 0.317605900659851
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Measuring the burden of disease and subsequent economic costs from environmental health risks is important in helping policy makers better integrate environmental health into economic development and specifically into their decisions relating to the allocation of resources among various programs and activities to improve child health

Label: 3, with a score of: 0.538829147555906
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Label: 10, with a score of: 0.363298691315928
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Building on previous estimates and taking into consideration the links between environmental health malnutrition and disease WHO recently revised the burden of disease estimates taking into account malnutrition mediated health impacts associated with inadequate water and sanitation coverage and improper hygienic practices Fewtrell and others

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WordScorePoS
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Label: 3, with a score of: 0.538038177365715
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Label: 12, with a score of: 0.298085936620201
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Label: 17, with a score of: 0.097877878359369
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The new WHO estimates reveal that the environmental health burden in children under five years is substantially higher when all links through malnutrition are incorporated

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Label: 1, with a score of: 0.329216171254898
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This finding is especially apparent in subregions such as SubSaharan Africa and South Asia where malnutrition and poor environmental conditions coexist

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Label: 8, with a score of: 0.404015061523787
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Label: 12, with a score of: 0.360259996813753
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In Sub Saharan Africa despite much poorer living standards fewer babies are born with low birth weight than in South Asia

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Label: 1, with a score of: 0.408020328568038
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This enigma may in part be explained by the poor survival rate of both fetuses and children in SubSaharan Africa as result of unhealthy environmental conditions

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Label: 8, with a score of: 0.38982693213307
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Label: 6, with a score of: 0.313905702859416
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Furthermore even when conservatively estimated multiplier effect exists for environmental health interventions investments addressing environmental risks such as lack of water and sanitation not only reduce diarrheal mortality but also reduce mortality from malnutrition related diseases and its consequences on education attainment

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Using case studies from Ghana and Pakistan chapter translates the burden into economic costs at country level

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In doing so it updates earlier estimates by providing measures of the total effects of environmental risks including those through malnutrition

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Also the report for the first time attempts to estimate the longer term impacts of these environmental health risks on cognition and learning and on future work productivity

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These revised estimates show that when malnutrition mediated health effects attributed to environmental health risks are included the total costs for Ghana and Pakistan range from to percent of country gross domestic product GDP see table

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These costs are at least percent higher than when malnutrition mediated effects are not included

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In the longer term malnutrition which is partly attributed to environmentrelated infections is found to affect child cognitive function school enrollment ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE

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Annual Cost of Direct and Indirect Impact of Environmental Risk Factors in Ghana Annual Deaths Cost million Cost US million Cost of GDP Annual Deaths Estimation Excluding Malnutrition Mediated Effects Mortality effects

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Estimation Including Malnutrition Mediated Effects Mortality effects

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Education effects

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Total effects

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Pakistan Cost Cost PRs US billion million Cost of GDP

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Source Compiled by World Bank team

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Note Ï­ Ghanaian new cedi

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grade repetition school dropout rate grade attainment and future incomeearning potential

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For Ghana and Pakistan the annual cost of stunting attributable to early childhood diarrheal infections is estimated to be to percent of the country GDP

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To estimate malnutrition mediated costs these analyses often rely on parameters from global and regional studies when corresponding country level data are unavailable

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Overall wherever assumptions are required the parameters have been conservatively chosen

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Thus when all effects through malnutrition are considered including education costs the total estimated annual costs may be as high as percent of country GDP see table

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This social and economic burden is not trivial

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It highlights the urgent need for policy makers to position environmental health at the center of all child survival strategies

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Experiences Chapter begins with historical review of environmental health outlining the trends in the evolution of environmental health functions in developed countries and highlighting how circumstances have led to the unfortunate neglect of environmental health in the development agenda

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Environmental health actions are the earliest public health activities on record

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Lessons from history have shown the enormous benefits of multisectoral environmental health actions with today developed countries having undergone an evolution in environmental health functions

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However both institutionally and conceptually environmental health has fallen through the cracks in the development agenda in the world poorest countries

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INTRODUCTION On the one hand there has been growing environmental movement with the creation of ministries of environment and accompanying policies and regulations

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On the other hand health ministries and state health departments have been engaged in scaling up vertical health sector programs which focus mainly on treatment

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This artificial separation of environment from traditional public health functions allows only limited multisectoral action that is needed to tackle environmental risks facing children under five

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Chapter then presents illustrative examples of how different developing countries have incorporated environmental health activities within other health nutrition and infrastructure programs

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Developing countries vary considerably in terms of institutional capacity political will and socioeconomic development

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Environmental health interventions therefore need to be customized to the specific enabling environment in developing country

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Recognizing those differences rather than providing specific recommendations the chapter presents some illustrative examples of ways in which some developing countries are beginning to mainstream environmental health components and objectives within existing child survival programs nutrition initiatives and infrastructure projects water and sanitation or rural energy projects

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Some common elements for successful environmental health actions in developing countries have included garnering high level political commitment involving and empowering communities allocating responsibilities and resources at the local level and finding balance between private and public sector roles

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common0JJ
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Furthermore successful environmental health governance requires strong institutional underpinnings with clearly articulated roles at all levels of administration within country

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The study provides discussion of the roles that national and local governments as well as the international community can play in delivering and managing environmental health interventions

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Label: 10, with a score of: 0.446225608764396
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Now is critical time for this agenda to take the forefront in developing countries with governments donors and civil society beginning to strengthen measures to address environmental health especially in the context of child survival

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Label: 17, with a score of: 0.473953290966038
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Label: 16, with a score of: 0.414639205165461
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Chapter highlights several key conclusions of this report â–  Diseases from environmental risk factors diarrheal diseases acute respiratory infections and malaria remain the top killers of children under five in developing countries

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Research evidence of the cycle of disease infections and malnutrition implies larger role for environmental health because it also indirectly contributes to other diseases by weakening the child immunity through malnutrition

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Environmental health actions also improve the effectiveness of other child health strategies

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â–  Specific subregions of the world such as Sub Saharan Africa and South Asia where poor environmental conditions and high malnutrition prevalence coexist should be especially targeted to fund and implement environmental ENVIRONMENTAL HEALTH AND CHILD SURVIVAL health interventions

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Label: 1, with a score of: 0.451530218538561
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Label: 12, with a score of: 0.367244638284511
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The multiplier effect of such interventions points to the potential of their significant health externalities

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At country level the burden of disease associated with environmental risk factors is as high as percent of country GDP significant enough for policy makers to consider environmental health programs in resource allocation decisions

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â–  Developing countries can learn from the experience of developed countries in addressing public health risks

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More than years ago today developed countries made deliberate attempts to improve environmental health conditions by specifically addressing sanitation and air pollution issues with relatively cost effective interventions

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Recent experience from for example the Ethiopian sanitation revolution has shown that improvements in rural settings in developing countries can also be achieved with modest fiscal inputs WSP but such improvements need to be backed by political support and community involvement

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The child health agenda remains unfinished in the developing world with millions of children continuing to fall sick and die from preventable environmental health causes

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Although considerable progress has been made the potential of environmental health actions to complement existing health infrastructure and environment management strategies remains largely untapped in the developing world

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In many ways this report represents first step toward providing policy makers with the epidemiological economic and experiential evidence to incorporate environmental health into the child survival agenda

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However additional research and studies will help donors and governments in developing countries choose appropriate environmental health interventions

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Such research efforts should include the following â–  Further research on environmental health impacts during pregnancy on additional disease transmission pathways and on better relative risk estimates will help improve disease burden and costing estimates

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â–  At country level cost effectiveness and cost benefit analyses are important follow up exercises that will help guide decision makers to prioritize among the various available interventions

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â–  more in depth country level institutional analysis is required of the coordination mechanisms between ministries and of the ways mandates and budgets are assigned

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Such analysis would help guide the roles and responsibilities of different agencies for better environmental health governance

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Label: 5, with a score of: 0.449544555039341
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Label: 12, with a score of: 0.448886589297431
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Label: 16, with a score of: 0.325889061225711
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In the longer term environmental health concerns are expected to grow

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Label: 17, with a score of: 0.400771735385991
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Label: 12, with a score of: 0.430766980105321
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Label: 10, with a score of: 0.386451658688464
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As the world climate changes diseases such as diarrhea and malaria among other important health burdens that are the result of environmental risk factors are likely to worsen particularly for the poor in developing countries CampbellLendrum Corvalán and Neira IPCC

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WordScorePoS
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Label: 13, with a score of: 0.320224876532981
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Thus scaling up preventive INTRODUCTION environmental health interventions to reduce the current burden of disease is prudent investment Campbell Lendrum Corvalán and Neira

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Given the multisectoral nature of environmental health issues the advocacy and regulatory roles of the health sector and the supporting roles of other sectors such as the environmental infrastructure agricultural and education sectors in promoting and delivering environmental health actions need to be revitalized

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Ultimately good environmental health governance will require policy makers to develop signaling mechanisms to identify environmental risks to translate these signals into appropriate interventions to adjust their policies to better address environmental health outcomes and to set up institutional mechanisms to successfully implement interventions

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concerted and continuous effort is needed on behalf of both developed and developing countries to ensure that environmental health is placed high on the development agenda and corresponding interventions must be financed and undertaken to improve children survival and development potential

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Label: 16, with a score of: 0.326101579894622
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Epidemiology H E Environmental Health Malnutrition and Child Health MALNUTRITION POOR ENVIRONMENTAL CONDITIONS and infectious diseases are highly associated geographically and take their heaviest tolls on children under five years of age in Sub Saharan Africa South Asia and certain countries in the Eastern Mediterranean region Ezzati Vander Hoorn and others Ezzati Rodgers and others

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Malnutrition is an underlying cause of child mortality that contributes to between

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percent and

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percent of the

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million deaths globally in children under five Caulfield and others Fishman and others

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Label: 16, with a score of: 0.301761697730081
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In addition childhood malnutrition is associated with disease poor mental development and reduced learning ability Alderman and others

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Because research and mainstream debate have revolved around how malnourished children are more susceptible to infectious diseases including diarrhea and acute respiratory infection ARI the links between environmental risk factors and malnutrition are less acknowledged

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This chapter revisits the links between malnutrition and environment related infections and seeks to demonstrate the importance of environmental health in child survival and growth

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An overview of past and recent research that shows the importance of repeated disease episodes such as diarrhea and malaria in the development of malnutrition is presented for detailed analysis see appendix

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Environmental Factors Exposure and Transmission Pathways Environmental health focuses on disease transmission routes rather than on how people are treated when they are sick

Label: 3, with a score of: 0.735515437012746
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The identification of transmission routes rather than the diseases themselves is the important conceptual framework and because diseases can be transmitted by more than one route environmental health interventions often make more sense at community level than at the level of individuals Yacoob and Kelly

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Table

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gives examples of the different transmission routes that various water related diseases can take

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Label: 12, with a score of: 0.247011192570465
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Such transmission routes have largely been blocked in the developed world

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In developing countries the poor continue to be exposed to many transmission routes at one time

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Understanding how different transmission routes affect disease outcomes especially for diarrhea is important because even when an intervention may aim at blocking one transmission route the effect on the disease may be limited because the population is still exposed through another transmission route see figure

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This concept is known as residual transmission Briscoe Cairncross Eisenberg Scott and Porco

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As Cairncross and Valdmanis point out practically all potentially waterborne infections that are transmitted by the feco oral route can potentially be transmitted by other means contamination of fingers food fomites field crops other fluids flies and so on all of which are water washed routes

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The pervasive nature of fecal pollution in developing countries see for example Kimani Murage and Ngindu makes effective prevention of disease by blocking just one transmission route difficult Eisenberg Scott and Porco TABLE

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Water Related Transmission Routes and Disease Outcome Transmission Route Waterborne Water washed Water based Water related insect vector Description Disease Group Examples Pathogen is ingested in drinking water Transmission by inadequate water for hygiene conditions and practices Feco oral infections Diarrhea dysentery typhoid fever Diarrhea dysentery typhoid fever acute lower respiratory infections scabies and trachoma Schistosomiasis guinea worm Transmission by means of aquatic invertebrate host Transmission by insect vector that breeds in or near water Most feco oral oro oral acute respiratory skin and eye infections Water based infections Water related insect vector infections Source Adapted from Cairncross and Valdmanis table

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Dengue malaria trypanosomiasis ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH FIGURE

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The Diagram Transmission Routes for Infection sanitation fluids water quality fields food feces new host flies fingers water quantity hand washing Source Hunt

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The provision of clean water one transmission route has often produced less than anticipated outcomes because water may be scarce or hygiene practices poor thus exposure remains through another transmission route

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The emphasis on drinking water possibly occurs because those living in affluent conditions with substantial water quantity and proper sanitation in their homes often ignore the other water washed transmission routes for diseases that poorer households with inadequate water for proper hygiene practices face

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This idea also has its roots in the historical drama of single source epidemics rather than in the longterm tragedy of endemic diarrhea

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Vicious Cycle of Infections and Malnutrition Infections and malnutrition operate in vicious cycle to affect child health

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Though the effect of malnutrition on disease is generally recognized the role of infections in the worsening of nutritional status has been relatively neglected

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Effect of Malnutrition on Disease Poor nutritional status especially in infants and young children makes infections worse and often more frequent

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WordScorePoS
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WordScorePoS
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Label: 2, with a score of: 0.458725275901362
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WordScorePoS
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Data from number of studies reviewed by Scrimshaw Taylor and Gordon provide evidence that moderate and severe undernutrition increases the seriousness of infections such as diarrhea and acute lower respiratory infection

Label: 10, with a score of: 0.363651464006426
WordScorePoS
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Increased mortality is an effect of malnutrition which makes individuals susceptible to infectious disease when illness occurs it is more severe and prolonged and carries an increased risk of death Scrimshaw Taylor and Gordon

Label: 3, with a score of: 0.928200374444452
WordScorePoS
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As predicted in malnutrition was convincingly established as potentiator of mortality in young children with the risk of death from all ENVIRONMENTAL HEALTH AND CHILD SURVIVAL infections increasing exponentially with decreasing nutritional status Caulfield and others Fishman and others Pelletier Pelletier and others

Label: 3, with a score of: 0.862048902297834
WordScorePoS
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Malnutrition can increase child susceptibility to infection by negatively affecting the barrier protection afforded by the skin and mucous membranes and by inducing alterations that reduce the child immunity Brown see figure

Label: 3, with a score of: 0.578362014810617
WordScorePoS
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WordScorePoS
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For example in malnourished child diarrhea can quickly result in life threatening dehydration caused by loss of water and minerals Thapar and Sanderson

Label: 6, with a score of: 0.832092870988939
WordScorePoS
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Label: 12, with a score of: 0.33109121825944
WordScorePoS
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Malnutrition also increases the duration of many infections the more severe the level of malnutrition the longer the illness lasts and the longer the child takes to recover Thapar and Sanderson

Label: 3, with a score of: 0.631711903524679
WordScorePoS
malnutrition0NN
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Effect of Infections on Malnutrition Up until the middle of the th century nutrition textbooks hardly ever mentioned the role of infections in the worsening of nutritional status which in turn reduces growth in children Keusch Scrimshaw

Label: 2, with a score of: 0.540352598748648
WordScorePoS
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Label: 8, with a score of: 0.349420758771606
WordScorePoS
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WordScorePoS
effect0NN
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Label: 3, with a score of: 0.495932505093829
WordScorePoS
effect0NN
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Even though historically vitamin deficiencies were known to be aggravated by infections the effect of diseases such as diarrhea and respiratory infections on malnutrition in children was not recognized and poor diets were considered to be predominantly responsible for poor growth in children Scrimshaw

Label: 3, with a score of: 0.619681808303026
WordScorePoS
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Label: 1, with a score of: 0.475678124002376
WordScorePoS
infection0NN
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Label: 8, with a score of: 0.275103592901054
WordScorePoS
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Label: 2, with a score of: 0.338544803397554
WordScorePoS
infection0NN
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Over the past several decades dozens of studies many of them long term cohort studies have investigated the causal relationship between disease and malnutrition and have provided conclusive evidence of how almost all infections influence child nutritional status see appendix

Label: 3, with a score of: 0.694386470715878
WordScorePoS
decade0NN
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Label: 10, with a score of: 0.37825172232896
WordScorePoS
decade0NN
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Label: 17, with a score of: 0.291768930212135
WordScorePoS
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Table

Label: 0, with a score of: 1

shows how infections adversely affect nutritional status in young children through reductions in food intake caused by loss of appetite as well as changes in intestinal absorption changes in metabolism and excretion of specific nutrients Scrimshaw Taylor FIGURE

Label: 2, with a score of: 0.582936196990919
WordScorePoS
infection0NN
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Label: 12, with a score of: 0.466888556619218
WordScorePoS
infection0NN
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Label: 3, with a score of: 0.359961128685133
WordScorePoS
infection0.122222546933424NN
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Label: 15, with a score of: 0.324186842934514
WordScorePoS
infection0NN
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Relationship between Nutrition and Infection decreased dietary intake infection malabsorption catabolism nutrient disposal nutrient sequestration Source Brown

Label: 2, with a score of: 0.518315850780532
WordScorePoS
nutrition0.175025014152344NN
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malnutrition impaired immune function impaired barrier protection ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH TABLE

Label: 3, with a score of: 0.656356360572
WordScorePoS
malnutrition0NN
function0NN
barrier0NN
protection0.020806307400253NN
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Label: 1, with a score of: 0.462119225838429
WordScorePoS
malnutrition0.0736315832425121NN
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child0.0450489732120807NN

Label: 5, with a score of: 0.300483721643791
WordScorePoS
malnutrition0NN
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Impact of Infection on Nutritional Status Infection Effect Nutritional Impact ARI diarrhea measles especially Acute and chronic diarrhea from bacteria viruses or intestinal helminths Anorexia Decrease in food intake Decrease in food intake Diarrhea Hookworms HIV infection or inflammation especially in smokers Many infections Malabsorption Effusion of serous fluid to gut traditionally treated by food withdrawal Intestinal bleeding Direct nutrient loss mostly to gut or urine Increased nutrient requirements Several mechanisms among infected individuals leading to reduced serum retinol iron and zinc concentrations relevance remains uncertain Increase in resting energy expenditure Diminished transport of micronutrients vitamin iron and zinc Source Based on Stephensen

Label: 3, with a score of: 0.498230119122242
WordScorePoS
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Label: 2, with a score of: 0.495152522042058
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impact0NN
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Note For all the diseases the stress fever or tissue damage caused by disease increases the food requirement while also reducing the intake and absorption of nutrients which leads to anorexia

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Label: 2, with a score of: 0.428111249238038
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Label: 12, with a score of: 0.396411897089347
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and Gordon Stephensen

Label: 0, with a score of: 1

These nutrient losses have implications for tissue synthesis and growth in young children and lead to growth faltering Brown

Label: 8, with a score of: 0.793694273945045
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Label: 10, with a score of: 0.383568674504924
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The effect of infections on the nutritional status of young children appears to be directly proportional to the severity of the infection Powanda and Beisel which means that children with more serious infections such as dysentery measles or pneumonia are more likely to become stunted than those with acute diarrhea see appendix

Label: 3, with a score of: 0.7994161337567
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Label: 2, with a score of: 0.42266152875513
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Numerous cohort studies have researched the impact of infections mostly diarrheal disease on weight and linear growth see box

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A recent Peruvian study found that children ill with diarrhea percent of the time during the first months of life were

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centimeters shorter than children who never had diarrhea Checkley and others

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Label: 4, with a score of: 0.439005712007529
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Label: 16, with a score of: 0.347374750571648
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Label: 2, with a score of: 0.314234936000714
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Another study from Brazil found that on average

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Label: 10, with a score of: 0.645358470006291
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diarrheal episodes before two years of age were associated with

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Label: 3, with a score of: 0.576372129004236
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centimeter growth shortfall at age seven years Moore and others

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Label: 1, with a score of: 0.49145381067894
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Label: 10, with a score of: 0.393433122311066
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Similarly Moore and colleagues found that early childhood helminthiasis infections caused by parasitic worms such as hookworms led to further

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centimeter growth reduction by age seven

Label: 8, with a score of: 0.639872475601483
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Label: 10, with a score of: 0.49162510978787
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Because early childhood growth faltering is known to predict height in adulthood Martorell the effects of infections on linear growth are considered irreversible Checkley and others

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In general effects on weight have been easier to demonstrate than effects on linear growth even in shorter follow up studies Stephensen

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Label: 10, with a score of: 0.377047750252233
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL BOX

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WordScorePoS
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Impact of Diarrhea on Child Malnutrition Evidence from Research Among the various infections diarrhea is one of the most prevalent in developing countries and is responsible for high proportion of sickness and death in children under five years of age Scrimshaw

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Because of its high occurrence and its involvement with the malabsorption of nutrients diarrhea has been key issue in child malnutrition Mata Scrimshaw

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The effects of different types of malnutrition on diarrheal illness have been studied over the past several decades Guerrant and others see accompanying figure

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Several studies in developing countries support the argument that an increased risk of diarrheal mortality is associated with low weight for age however the effect on diarrheal incidence has been less clear

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WordScorePoS
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Evidence now supports the idea that incidence is increased Fishman and others

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Effects of Diarrhea and Malnutrition diarrhea incidence duration severity weight gain short term malnutrition height gain long term Source Guerrant and others

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WordScorePoS
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Scrimshaw Taylor and Gordon summarized the evidence on how infections have deleterious although often ignored effect on nutritional status

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WordScorePoS
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By the metabolic consequences of infections were already well established Powanda and Beisel

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A major problem in the review was that long term human follow up information was lacking Scrimshaw

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After about cohort follow up studies have produced information on this topic

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Practically all the cohort studies see appendix favor the idea that not only diarrheal disease but also other infections for example helminths measles and acute lower respiratory infections cause growth to falter

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WordScorePoS
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This view was strengthened because investigators could show larger effects on nutritional status with increasing frequency and severity of infections

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WordScorePoS
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Some inconsistencies and weak observed effects can be explained by the mitigating effects of breastfeeding and other factors that effectively mask effects of infections on growth faltering in these studies see appendix

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Experimental clinical trial information on deworming of continued ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH children further supports causal inference between infection and poor growth Taylor Robinson Jones and Garner

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WordScorePoS
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The debate in the focused on whether these effects could be reversed although even those who suggested that subsequent catch up growth corrects much of the growth faltering recognize the failure in children with persistent diarrhea that is those who have diarrhea more than percent of the time Bairagi and others Briend and others Moy and others

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Several studies during the past decade have shown that if infection burden begins before six months of age lagging linear growth effects that are observed are likely to be irreversible Adair and others Brush Harrison and Waterlow Checkley and others Moore and others which diminishes the possibility that malnourishment in the first place made the host more susceptible and that observed effects would result from reverse causality rather than true causality see appendix

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A WHO collective expert opinion Prüss Üstün and Corvalán states that percent of consequences of maternal and childhood underweight is attributable to lack of water sanitation and hygiene

Label: 6, with a score of: 0.937257907799923
WordScorePoS
maternal0JJ
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Label: 3, with a score of: 0.221425008671915
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The idea that infections affect child nutritional status has faced some skepticism

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Label: 9, with a score of: 0.356364719397259
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Label: 11, with a score of: 0.307210240245192
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Even while skeptics have agreed that in the short term the adverse metabolic effects from infections do lead to growth faltering in children they have argued that subsequent catch up growth fully compensates for these adverse effects of infection in the majority of children Bairagi and others Briend and others Moy and others see also appendix

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Label: 17, with a score of: 0.185852265608903
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Part of the reason for this skepticism and controversy about the impact of infections on growth faltering in children lay in the paucity of direct long term human observations indicating the irreversibility of these effects Scrimshaw

Label: 8, with a score of: 0.493459881999153
WordScorePoS
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Label: 10, with a score of: 0.395050803490887
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Compelling evidence of this irreversibility was not gained until early see appendix

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Label: 12, with a score of: 0.42088608507283
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Environmental Role in Early Childhood Health Environmental health inputs at both the household and the community levels play critical role in child survival and growth see figure

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WordScorePoS
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Label: 8, with a score of: 0.359144226145859
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Label: 10, with a score of: 0.35619323727621
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Label: 9, with a score of: 0.30273039548382
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and appendix for further detail

Label: 0, with a score of: 1

In the life cycle of child from the womb to the age of about two years environmental health interventions such as access to water and sanitation proper hygiene practices proper vector control and the use of cleaner fuels for cooking and heating are especially critical for preventing growth faltering in the fetus and infant which has consequences for child subsequent health

Label: 6, with a score of: 0.599040951699493
WordScorePoS
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Label: 12, with a score of: 0.305532703841503
WordScorePoS
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Label: 8, with a score of: 0.203819769552664
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These impacts on child growth have also been seen to result in cognition and learning problems as well as chronic diseases later in life an issue discussed in more detail later in this chapter

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Label: 6, with a score of: 0.410592261041384
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE

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WordScorePoS
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Environmental Health Inputs and Health Outcomes in the Child Life Cycle pregnancy early infancy years example of inputs health outcomes birth and perinatal early childhood years postneonatal postweaning peri or postneonatal deaths number of infectious disease episodes underweight infant and under deaths incidence of diarrhea ARI malaria malnutrition acute anemia placental insufficiency fetal loss stillbirths chronic restricted growth environmental health vector control safe water improved sanitation indoor air pollution mitigation safe water improved sanitation vector control indoor air pollution mitigation hygiene promotion safe water improved sanitation vector control indoor air pollution mitigation hygiene promotion other prenatal care proper breastfeeding immunizations micronutrient supplementation better case management immunizations micronutrient supplementation better case management stunting cognitive and learning impairments school performance work productivity chronic diseases such as coronary disease and obesity Source Adapted from World Bank a

Label: 6, with a score of: 0.71492166674115
WordScorePoS
environmental0JJ
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Label: 3, with a score of: 0.482298757824073
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Label: 12, with a score of: 0.226046383048085
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Label: 4, with a score of: 0.173292009737036
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Label: 8, with a score of: 0.0846443377110468
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The following sections discuss the specific roles of environmental health actions in the life cycle of child from pregnancy and protection of the fetus to early infancy when growth faltering effects are irreversible to early childhood when both household and community level actions can make difference

Label: 3, with a score of: 0.373740589582295
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Label: 8, with a score of: 0.329521128322007
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Label: 12, with a score of: 0.416551685948312
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child0NN
protection0NN
growth0NN
effect0NN
childhood0NN
household0.0554128417527413NN
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level0.00513687014008325NN

Label: 10, with a score of: 0.378843980320956
WordScorePoS
specific0JJ
environmental0.0237821918091848JJ
health0.0405241466500776NN
action0.0145231653596925NN
life0NN
cycle0NN
child0.0242343960710022NN
protection0.0660824365173543NN
growth0.11178243319132NN
effect0NN
childhood0NN
household0.0330412182586772NN
community0.0202620733250388NN
level0NN

Label: 1, with a score of: 0.377920080174114
WordScorePoS
specific0JJ
environmental0.0442083771593746JJ
health0NN
action0.0269969049497485NN
life0.0184786920895884NN
cycle0NN
child0.0450489732120807NN
protection0.122839698738001NN
growth0.0519476926891779NN
effect0NN
childhood0NN
household0NN
community0NN
level0.0113874611101829NN

Finally the longer term effects specifically in terms of cognition and learning are discussed

Label: 17, with a score of: 0.701671815752572
WordScorePoS
term0.149793392961411NN
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learn0VB

Label: 4, with a score of: 0.572700027260372
WordScorePoS
term0NN
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learn0.244520809605025VB

Pregnancy Protecting the Fetus Nutrition plays crucial role in the growth and the development of the fetus

Label: 8, with a score of: 0.587621895459811
WordScorePoS
protect0.0180650490434051VB
nutrition0NN
crucial0JJ
growth0.208565600657229NN
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Label: 2, with a score of: 0.580453523417237
WordScorePoS
protect0.0130963126055467VB
nutrition0.175025014152344NN
crucial0JJ
growth0.0252000451111224NN
development0.0159922815774215NN

Label: 10, with a score of: 0.327842007912511
WordScorePoS
protect0VB
nutrition0NN
crucial0JJ
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Label: 9, with a score of: 0.30175714442075
WordScorePoS
protect0VB
nutrition0NN
crucial0.0602029956716497JJ
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During pregnancy the mother own nutritional status and exposure to infections have an important effect on the fetus Fishman and others

Label: 3, with a score of: 0.85175638153865
WordScorePoS
mother0.162963395911232NN
nutritional0JJ
status0NN
exposure0NN
infection0.122222546933424NN
effect0NN

Label: 1, with a score of: 0.359195669760857
WordScorePoS
mother0NN
nutritional0JJ
status0NN
exposure0.120266261535276NN
infection0NN
effect0NN

Label: 2, with a score of: 0.305864967435668
WordScorePoS
mother0NN
nutritional0.0583416713841148JJ
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infection0NN
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The impact of infections on malnourishment of the fetus and subsequent growth faltering has been inadequately studied Breman Alilio and Mills

Label: 8, with a score of: 0.683667458590718
WordScorePoS
impact0NN
infection0NN
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Label: 3, with a score of: 0.400639308597135
WordScorePoS
impact0NN
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Whereas some infectious diseases for example rubella can infect the fetus through the placenta other infections for example malaria and hookworm can induce fetal death stillbirths and perinatal deaths as well as contribute to poor fetal growth without infecting the fetus van Geertruyden and others

Label: 3, with a score of: 0.897889005095139
WordScorePoS
disease0.215415047323213NN
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malaria0.20370424488904NN
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growth0NN

Label: 8, with a score of: 0.20169212169363
WordScorePoS
disease0NN
infection0NN
malaria0NN
death0NN
contribute0VB
poor0JJ
growth0.208565600657229NN

Label: 1, with a score of: 0.19593009468006
WordScorePoS
disease0NN
infection0NN
malaria0NN
death0NN
contribute0VB
poor0.150659516460257JJ
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In addition to experiencing micronutrient deficiencies pregnant women in developing countries are exposed to numerous environmental risks

Label: 5, with a score of: 0.550330858061213
WordScorePoS
addition0NN
experience0NN
pregnant0JJ
woman0.221979360474357NN
develop0VB
country0NN
environmental0JJ
risk0NN

Label: 2, with a score of: 0.431118522220867
WordScorePoS
addition0.0357189919948307NN
experience0NN
pregnant0.0583416713841148JJ
woman0.0546336178945768NN
develop0VB
country0NN
environmental0JJ
risk0.0252000451111224NN

Label: 11, with a score of: 0.357868545893745
WordScorePoS
addition0NN
experience0NN
pregnant0JJ
woman0.0273960270556257NN
develop0VB
country0NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN

Label: 1, with a score of: 0.350075305848562
WordScorePoS
addition0NN
experience0NN
pregnant0JJ
woman0.0450489732120807NN
develop0VB
country0NN
environmental0.0442083771593746JJ
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Label: 3, with a score of: 0.330935318819834
WordScorePoS
addition0NN
experience0.0249430985430622NN
pregnant0JJ
woman0.0381514605760894NN
develop0VB
country0NN
environmental0JJ
risk0.0703902516159815NN

Malaria is ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH endemic across the tropics and subtropics and it thrives in areas with poor drainage and stagnant water

Label: 3, with a score of: 0.619445890358879
WordScorePoS
malaria0.20370424488904NN
environmental0JJ
health0.191387734041787NN
malnutrition0NN
child0.10682408961305NN
thrive0VB
poor0JJ
water0.0382775468083574NN

Label: 6, with a score of: 0.582580415320865
WordScorePoS
malaria0NN
environmental0JJ
health0NN
malnutrition0.041835863322702NN
child0.0255958462813622NN
thrive0VB
poor0.0642010940957526JJ
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Label: 12, with a score of: 0.295223900688134
WordScorePoS
malaria0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
malnutrition0NN
child0NN
thrive0VB
poor0.0339811641917276JJ
water0.186896403054502NN

Label: 1, with a score of: 0.265488313757253
WordScorePoS
malaria0NN
environmental0.0442083771593746JJ
health0NN
malnutrition0.0736315832425121NN
child0.0450489732120807NN
thrive0VB
poor0.150659516460257JJ
water0NN

Areas with bad sanitation provide prime conditions for hookworm infections Hotez and others

Label: 6, with a score of: 0.865681998858412
WordScorePoS
bad0.0683326727248364JJ
sanitation0.334686906581616NN
provide0VB
condition0NN
infection0NN

Label: 3, with a score of: 0.337626984733909
WordScorePoS
bad0JJ
sanitation0.0249430985430622NN
provide0.0100171139310145VB
condition0NN
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In many developing countries and especially among the poor malaria and hookworm infections coexist both synergistically affecting the health of the pregnant woman and her unborn child Watson Jones and others

Label: 3, with a score of: 0.776276373378592
WordScorePoS
develop0VB
country0NN
poor0JJ
malaria0.20370424488904NN
infection0.122222546933424NN
affect0.00625975725959118VB
health0.191387734041787NN
pregnant0JJ
woman0.0381514605760894NN
child0.10682408961305NN

Label: 5, with a score of: 0.343882318551599
WordScorePoS
develop0VB
country0NN
poor0JJ
malaria0NN
infection0NN
affect0VB
health0.0571058915334038NN
pregnant0JJ
woman0.221979360474357NN
child0.0170753354211044NN

Label: 1, with a score of: 0.301008080780753
WordScorePoS
develop0VB
country0NN
poor0.150659516460257JJ
malaria0NN
infection0NN
affect0.0184786920895884VB
health0NN
pregnant0JJ
woman0.0450489732120807NN
child0.0450489732120807NN

Anemia in pregnancy which is associated with increased risks of premature labor and low birth weight Watson Jones and others is multifactoral condition and is often caused by combination of malaria hookworm infections and dietary deficiencies Menendez Fleming and Alonso Watson Jones and others see also box

Label: 3, with a score of: 0.911572756051388
WordScorePoS
increase0.0143984997539974NN
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premature0.0407408489778079JJ
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condition0NN
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malaria0.20370424488904NN
infection0.122222546933424NN
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Malaria

Label: 3, with a score of: 1
WordScorePoS
malaria0.20370424488904NN

Every year approximately million pregnant women worldwide are exposed to malaria million of these women live in the African region Crawley and others

Label: 5, with a score of: 0.61300419684405
WordScorePoS
approximately0RB
pregnant0JJ
woman0.221979360474357NN
worldwide0RB
malaria0NN
live0VB
african0IN
region0.0465610847355851NN

Label: 3, with a score of: 0.543491386124134
WordScorePoS
approximately0RB
pregnant0JJ
woman0.0381514605760894NN
worldwide0RB
malaria0.20370424488904NN
live0.0300513417930436VB
african0IN
region0.124837844401518NN

Label: 1, with a score of: 0.43525083536501
WordScorePoS
approximately0RB
pregnant0JJ
woman0.0450489732120807NN
worldwide0RB
malaria0NN
live0.0739258553811849VB
african0IN
region0.184259548107002NN

Malarial infection during pregnancy is an important and preventable environmental cause of low birth weight Allen and others van BOX

Label: 3, with a score of: 0.844912388191813
WordScorePoS
infection0.122222546933424NN
preventable0.0307735781890304JJ
environmental0JJ
birth0.0748292956291867NN

Overweight Mothers Carrying Underweight Children It is not uncommon in developing countries to see overweight mothers carrying underweight babies

Label: 3, with a score of: 0.927141602775379
WordScorePoS
overweight0JJ
mother0.162963395911232NN
child0.10682408961305NN
develop0VB
country0NN

These images effectively convey the message that not food security but repeated infections from poor environmental health conditions often contribute to undernutrition among children World Bank

Label: 2, with a score of: 0.640635641738694
WordScorePoS
effectively0RB
food0.292342270824999NN
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infection0NN
poor0.0548141757796873JJ
environmental0JJ
health0NN
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contribute0.0297950283197006VB
child0.0546336178945768NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 3, with a score of: 0.434214530601184
WordScorePoS
effectively0RB
food0NN
security0NN
infection0.122222546933424NN
poor0JJ
environmental0JJ
health0.191387734041787NN
condition0NN
contribute0VB
child0.10682408961305NN
world0.00087176582269799NN
bank0NN

Label: 12, with a score of: 0.428458584472802
WordScorePoS
effectively0RB
food0.186896403054502NN
security0NN
infection0NN
poor0.0339811641917276JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
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contribute0.0554128417527413VB
child0NN
world0.00464349782489754NN
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Label: 1, with a score of: 0.249919961856299
WordScorePoS
effectively0RB
food0NN
security0NN
infection0NN
poor0.150659516460257JJ
environmental0.0442083771593746JJ
health0NN
condition0NN
contribute0VB
child0.0450489732120807NN
world0.00257343720272548NN
bank0NN

Moreover food requirements during early childhood the window of opportunity are small World Bank

Label: 2, with a score of: 0.859053092229496
WordScorePoS
food0.292342270824999NN
childhood0NN
opportunity0.0261926252110933NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 12, with a score of: 0.39255828549042
WordScorePoS
food0.186896403054502NN
childhood0NN
opportunity0NN
world0.00464349782489754NN
bank0NN

Even where food scarcity is concern the lack of affordable environmental health services such as clean water only aggravates the situation diverting resources from the family food budget and thus contributing indirectly to the child poor nutritional status Cairncross and Kinnear

Label: 6, with a score of: 0.58692823544615
WordScorePoS
food0.0214003646985842NN
scarcity0.273330690899345NN
lack0.0214003646985842NN
affordable0.0214003646985842JJ
environmental0JJ
health0NN
service0.0084006124696649NN
clean0.0348974218717993JJ
water0.556409482163189NN
situation0.0295155485671997NN
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family0.0348974218717993NN
contribute0VB
indirectly0RB
child0.0255958462813622NN
poor0.0642010940957526JJ
nutritional0JJ
status0NN

Label: 2, with a score of: 0.463683570707251
WordScorePoS
food0.292342270824999NN
scarcity0NN
lack0NN
affordable0JJ
environmental0JJ
health0NN
service0.0143446978608332NN
clean0JJ
water0NN
situation0.0252000451111224NN
resource0.0358563662904843NN
family0.0297950283197006NN
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indirectly0RB
child0.0546336178945768NN
poor0.0548141757796873JJ
nutritional0.0583416713841148JJ
status0NN

Label: 12, with a score of: 0.413930016093004
WordScorePoS
food0.186896403054502NN
scarcity0NN
lack0NN
affordable0JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
service0.00666957305782837NN
clean0JJ
water0.186896403054502NN
situation0NN
resource0.0416785799329393NN
family0NN
contribute0.0554128417527413VB
indirectly0RB
child0NN
poor0.0339811641917276JJ
nutritional0JJ
status0NN

Label: 1, with a score of: 0.253645963605508
WordScorePoS
food0NN
scarcity0NN
lack0.0753297582301286NN
affordable0JJ
environmental0.0442083771593746JJ
health0NN
service0.0443555132287109NN
clean0JJ
water0NN
situation0.0519476926891779NN
resource0.0739147683583536NN
family0NN
contribute0VB
indirectly0RB
child0.0450489732120807NN
poor0.150659516460257JJ
nutritional0JJ
status0NN

Label: 3, with a score of: 0.237859454651719
WordScorePoS
food0NN
scarcity0NN
lack0NN
affordable0.025518364538905JJ
environmental0JJ
health0.191387734041787NN
service0.0100171139310145NN
clean0.020806307400253JJ
water0.0382775468083574NN
situation0NN
resource0NN
family0.0624189222007589NN
contribute0VB
indirectly0RB
child0.10682408961305NN
poor0JJ
nutritional0JJ
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Label: 7, with a score of: 0.189067398062745
WordScorePoS
food0.0383371018038178NN
scarcity0NN
lack0.0383371018038178NN
affordable0.0766742036076356JJ
environmental0JJ
health0NN
service0.0451471467893167NN
clean0.125032076213024JJ
water0NN
situation0NN
resource0NN
family0NN
contribute0VB
indirectly0RB
child0NN
poor0JJ
nutritional0JJ
status0NN

key feature in the fetal programming or Barker hypothesis is that being underweight in early infancy or even earlier in the womb makes the child more susceptible to rebound growth if food becomes available in abundance

Label: 2, with a score of: 0.690059059408441
WordScorePoS
key0.0297950283197006NN
feature0NN
child0.0546336178945768NN
growth0.0252000451111224NN
food0.292342270824999NN

Label: 8, with a score of: 0.435665679594355
WordScorePoS
key0NN
feature0NN
child0.0452169560888236NN
growth0.208565600657229NN
food0NN

Label: 12, with a score of: 0.320842966886638
WordScorePoS
key0NN
feature0NN
child0NN
growth0NN
food0.186896403054502NN

Thus those girls who were growth restricted in the womb or became stunted in early infancy could be susceptible to overweight and related chronic disease later in life Eriksson Sachdev and others

Label: 5, with a score of: 0.598396351283191
WordScorePoS
girl0.393804437159645NN
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stunt0NN
overweight0JJ
related0JJ
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disease0NN
life0.0140083044329373NN

Label: 3, with a score of: 0.448660395796382
WordScorePoS
girl0.0527926887119861NN
growth0NN
stunt0NN
overweight0JJ
related0.0125195145191824JJ
chronic0JJ
disease0.215415047323213NN
life0.0250390290383647NN

Label: 8, with a score of: 0.342322099107943
WordScorePoS
girl0NN
growth0.208565600657229NN
stunt0NN
overweight0JJ
related0.0123650647908625JJ
chronic0JJ
disease0NN
life0.0123650647908625NN

Label: 4, with a score of: 0.225011570632167
WordScorePoS
girl0.140824109342254NN
growth0NN
stunt0NN
overweight0JJ
related0JJ
chronic0JJ
disease0NN
life0.0125233923809486NN

Label: 6, with a score of: 0.372077432147022
WordScorePoS
girl0.0295155485671997NN
growth0NN
stunt0NN
overweight0JJ
related0.0524959536790166JJ
chronic0.0683326727248364JJ
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life0NN

Environmental health conditions have either more distal effects that is the mother own irreversibly developed underweight status during early infancy or in womb or more proximate effects that is malaria and hookworms that effectively reduce birth weight

Label: 3, with a score of: 0.86555932369825
WordScorePoS
environmental0JJ
health0.191387734041787NN
condition0NN
effect0NN
mother0.162963395911232NN
develop0VB
status0NN
malaria0.20370424488904NN
effectively0RB
reduce0.01675146888405VB
birth0.0748292956291867NN

Although reduced birth weight is strong predictor of subsequent underweight status or stunting adverse effects of environmental health conditions on fetal growth cannot be incorporated in cohort studies that have studied the effects of infections on growth faltering see box

Label: 8, with a score of: 0.586430344891976
WordScorePoS
reduce0.0055149369084567VB
birth0NN
strong0JJ
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stunt0NN
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environmental0.0295821503613099JJ
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condition0.121575732851624NN
growth0.208565600657229NN
study0NN
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Label: 3, with a score of: 0.414107109180475
WordScorePoS
reduce0.01675146888405VB
birth0.0748292956291867NN
strong0JJ
status0NN
stunt0NN
adverse0JJ
effect0NN
environmental0JJ
health0.191387734041787NN
condition0NN
growth0NN
study0NN
infection0.122222546933424NN

Label: 10, with a score of: 0.466296448104672
WordScorePoS
reduce0.0310356414389692VB
birth0.0396106020715138NN
strong0.0488696285210061JJ
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stunt0NN
adverse0JJ
effect0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
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growth0.11178243319132NN
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and appendix

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Geertruyden and others

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN

Malaria is thought to affect child birth weight in two ways first through placental infection and second through malariainduced maternal anemia Menendez Fleming and Alonso

Label: 3, with a score of: 0.941834637493858
WordScorePoS
malaria0.20370424488904NN
affect0.00625975725959118VB
child0.10682408961305NN
birth0.0748292956291867NN
infection0.122222546933424NN
maternal0.184641469134183JJ

Placental infection appears to be associated with significant reduction in birth weight and with increased risk of low that is under kilograms birth weight Menendez Fleming and Alonso

Label: 3, with a score of: 0.786464285231548
WordScorePoS
infection0.122222546933424NN
significant0.0127591822694525JJ
reduction0.0149758277542848NN
birth0.0748292956291867NN
increase0.0143984997539974NN
risk0.0703902516159815NN

One review estimates that in areas where malaria is endemic one fifth of babies with low birth weight are underweight because of malarial infection of the placenta while the mother was pregnant Menendez Fleming and Alonso

Label: 3, with a score of: 0.977701906611104
WordScorePoS
review0NN
estimate0.059903311017139NN
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birth0.0748292956291867NN
infection0.122222546933424NN
mother0.162963395911232NN
pregnant0JJ

Malaria also clearly contributes to maternal anemia approximately pregnant women develop moderate or severe anemia each year in Sub Saharan Africa because of malaria infection Guyatt and Snow

Label: 3, with a score of: 0.907060373793065
WordScorePoS
malaria0.20370424488904NN
contribute0VB
maternal0.184641469134183JJ
approximately0RB
pregnant0JJ
woman0.0381514605760894NN
develop0VB
saharan0.0299516555085695JJ
africa0IN
infection0.122222546933424NN
snow0NN

Label: 5, with a score of: 0.296209879347796
WordScorePoS
malaria0NN
contribute0VB
maternal0JJ
approximately0RB
pregnant0JJ
woman0.221979360474357NN
develop0VB
saharan0.0335134328085675JJ
africa0IN
infection0NN
snow0NN

Hookworm infections

Label: 3, with a score of: 1
WordScorePoS
infection0.122222546933424NN

Hookworm infections are common worldwide but thrive in poor communities in the tropics where poor water supply and poor sanitation are common Steketee

Label: 6, with a score of: 0.832597300568551
WordScorePoS
infection0NN
common0JJ
worldwide0RB
thrive0VB
poor0.0642010940957526JJ
community0.0214003646985842NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN

Label: 1, with a score of: 0.323259218403658
WordScorePoS
infection0NN
common0JJ
worldwide0RB
thrive0VB
poor0.150659516460257JJ
community0NN
water0NN
supply0NN
sanitation0NN

Label: 12, with a score of: 0.269012427799137
WordScorePoS
infection0NN
common0JJ
worldwide0RB
thrive0VB
poor0.0339811641917276JJ
community0.0169905820958638NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN

Data from the early suggested that about third of the pregnant women in the developing world harbored hookworm infection Steketee

Label: 5, with a score of: 0.651530604186328
WordScorePoS
datum0NN
suggest0VB
pregnant0JJ
woman0.221979360474357NN
develop0VB
world0.00585260443759492NN
infection0NN

Label: 3, with a score of: 0.461114208281648
WordScorePoS
datum0NN
suggest0VB
pregnant0JJ
woman0.0381514605760894NN
develop0VB
world0.00087176582269799NN
infection0.122222546933424NN

Label: 2, with a score of: 0.358775251355978
WordScorePoS
datum0NN
suggest0VB
pregnant0.0583416713841148JJ
woman0.0546336178945768NN
develop0VB
world0.0124838525528648NN
infection0NN

Label: 9, with a score of: 0.309572950112695
WordScorePoS
datum0.0454743001434393NN
suggest0.0602029956716497VB
pregnant0JJ
woman0NN
develop0VB
world0.00257642711761688NN
infection0NN

Few studies have looked at the impact of hookworm infections on pregnant women Steketee

Label: 5, with a score of: 0.649271961298942
WordScorePoS
study0NN
impact0NN
infection0NN
pregnant0JJ
woman0.221979360474357NN

Label: 3, with a score of: 0.469081207255309
WordScorePoS
study0NN
impact0NN
infection0.122222546933424NN
pregnant0JJ
woman0.0381514605760894NN

Label: 2, with a score of: 0.330443729054553
WordScorePoS
study0NN
impact0NN
infection0NN
pregnant0.0583416713841148JJ
woman0.0546336178945768NN

Some studies in Nepal however showed that hookworm infection exacerbated iron deficiency and anemia in pregnant women

Label: 5, with a score of: 0.702508538165686
WordScorePoS
study0NN
infection0NN
pregnant0JJ
woman0.221979360474357NN

Label: 3, with a score of: 0.507543175791317
WordScorePoS
study0NN
infection0.122222546933424NN
pregnant0JJ
woman0.0381514605760894NN

Label: 2, with a score of: 0.357538219546259
WordScorePoS
study0NN
infection0NN
pregnant0.0583416713841148JJ
woman0.0546336178945768NN

Indoor air pollution

Label: 14, with a score of: 0.605812469342387
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN

Label: 12, with a score of: 0.497027388029788
WordScorePoS
air0.0554128417527413NN
pollution0.0234335422829798NN

Label: 11, with a score of: 0.434600238273636
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN

Label: 6, with a score of: 0.372116900223995
WordScorePoS
air0NN
pollution0.0590310971343993NN

Apart from parasitic infections such as malaria and hookworms indoor air pollution adversely affects the health of pregnant women

Label: 3, with a score of: 0.824074617507996
WordScorePoS
infection0.122222546933424NN
malaria0.20370424488904NN
air0.020806307400253NN
pollution0.0175975629039954NN
affect0.00625975725959118VB
health0.191387734041787NN
pregnant0JJ
woman0.0381514605760894NN

Label: 5, with a score of: 0.383229000758521
WordScorePoS
infection0NN
malaria0NN
air0NN
pollution0NN
affect0VB
health0.0571058915334038NN
pregnant0JJ
woman0.221979360474357NN

Biomass is often used for cooking and heating in developing countries leading to smoky kitchens and high levels of particulate matter

Label: 7, with a score of: 0.922809810746132
WordScorePoS
cooking0.122412709674631NN
heating0.122412709674631NN
develop0VB
country0NN
lead0.0383371018038178NN
level0NN

These conditions have been shown to lead to various respiratory infections in women and young children who are the most exposed because of time spent near the stove Bruce Perez Padilla and Albalak

Label: 5, with a score of: 0.436267469827287
WordScorePoS
condition0NN
lead0NN
infection0NN
woman0.221979360474357NN
child0.0170753354211044NN
time0NN

Label: 3, with a score of: 0.557483657756225
WordScorePoS
condition0NN
lead0.025518364538905NN
infection0.122222546933424NN
woman0.0381514605760894NN
child0.10682408961305NN
time0.0127591822694525NN

Label: 8, with a score of: 0.478902497227613
WordScorePoS
condition0.121575732851624NN
lead0.0504071033101074NN
infection0NN
woman0.0452169560888236NN
child0.0452169560888236NN
time0NN

Two studies have implicated indoor air pollution in low birth weight and perinatal mortality

Label: 3, with a score of: 0.893340036482342
WordScorePoS
study0NN
air0.020806307400253NN
pollution0.0175975629039954NN
birth0.0748292956291867NN
mortality0.276962203701274NN

A study in rural Guatemala found that birth weight was grams lower for babies born in households using wood than for those born in households using cleaner fuels and study in Zimbabwe showed an association between perinatal mortality and exposure to indoor air pollution WHO

Label: 3, with a score of: 0.712974038242914
WordScorePoS
study0NN
rural0JJ
birth0.0748292956291867NN
bear0.0814816979556159NN
household0NN
wood0NN
cleaner0JJR
fuel0NN
mortality0.276962203701274NN
exposure0NN
air0.020806307400253NN
pollution0.0175975629039954NN

Label: 2, with a score of: 0.268822589257627
WordScorePoS
study0NN
rural0.148975141598503JJ
birth0NN
bear0NN
household0.0297950283197006NN
wood0NN
cleaner0JJR
fuel0NN
mortality0NN
exposure0NN
air0NN
pollution0NN

Label: 7, with a score of: 0.373556649299066
WordScorePoS
study0NN
rural0JJ
birth0NN
bear0NN
household0NN
wood0.122412709674631NN
cleaner0.0924643738905717JJR
fuel0.0749457204978913NN
mortality0NN
exposure0NN
air0NN
pollution0NN

The association of indoor air pollution with growth faltering however is far less clear Smith Mehta and Maeusezahl Feuz than the association with malaria Watson Jones and others

Label: 3, with a score of: 0.641784536390183
WordScorePoS
air0.020806307400253NN
pollution0.0175975629039954NN
growth0NN
malaria0.20370424488904NN

Label: 8, with a score of: 0.552869436936787
WordScorePoS
air0NN
pollution0NN
growth0.208565600657229NN
malaria0NN

Early Infancy The Window of Opportunity Several studies that looked at the impact of infections on child growth have shown that exposure to environmental health risks in early infancy leads to permanent growth faltering lowered immunity and increased mortality figure

Label: 3, with a score of: 0.654397581751597
WordScorePoS
opportunity0NN
study0NN
impact0NN
infection0.122222546933424NN
child0.10682408961305NN
growth0NN
exposure0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
lead0.025518364538905NN
increase0.0143984997539974NN
mortality0.276962203701274NN
figure0NN

Label: 8, with a score of: 0.47443238786372
WordScorePoS
opportunity0.0361300980868102NN
study0NN
impact0NN
infection0NN
child0.0452169560888236NN
growth0.208565600657229NN
exposure0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
lead0.0504071033101074NN
increase0.00711043475673939NN
mortality0NN
figure0NN

Label: 10, with a score of: 0.318309238263179
WordScorePoS
opportunity0.029046330719385NN
study0NN
impact0NN
infection0NN
child0.0242343960710022NN
growth0.11178243319132NN
exposure0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN
lead0NN
increase0.00285817158600878NN
mortality0.0488696285210061NN
figure0NN

see also appendix

Label: 0, with a score of: 1

Averting repeated disease episodes especially in the first two years of life the window of opportunity prevents the more permanent and devastating wasting and stunting which have longer term implications for child health and prognosis World Bank

Label: 3, with a score of: 0.714419511789558
WordScorePoS
avert0.0814816979556159VB
disease0.215415047323213NN
life0.0250390290383647NN
opportunity0NN
prevent0VB
waste0NN
stunt0NN
term0NN
child0.10682408961305NN
health0.191387734041787NN
world0.00087176582269799NN
bank0NN

Label: 12, with a score of: 0.232568988050139
WordScorePoS
avert0VB
disease0NN
life0.0250071479597636NN
opportunity0NN
prevent0VB
waste0.138532104381853NN
stunt0NN
term0NN
child0NN
health0.0339811641917276NN
world0.00464349782489754NN
bank0NN

Label: 17, with a score of: 0.219660692577533
WordScorePoS
avert0VB
disease0NN
life0NN
opportunity0NN
prevent0VB
waste0NN
stunt0NN
term0.149793392961411NN
child0NN
health0NN
world0.00418824502414673NN
bank0.036961556179878NN

Label: 2, with a score of: 0.411520641390674
WordScorePoS
avert0VB
disease0NN
life0NN
opportunity0.0261926252110933NN
prevent0.0297950283197006VB
waste0.0297950283197006NN
stunt0.11668334276823NN
term0NN
child0.0546336178945768NN
health0NN
world0.0124838525528648NN
bank0.0881366997038154NN

ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH FIGURE

Label: 3, with a score of: 0.787669047522539
WordScorePoS
environmental0JJ
health0.191387734041787NN
malnutrition0NN
child0.10682408961305NN
figure0NN

The Window of Opportunity for Addressing Undernutrition

Label: 10, with a score of: 0.764377090252738
WordScorePoS
opportunity0.029046330719385NN
address0.064698038783335NN

Label: 7, with a score of: 0.448114650565527
WordScorePoS
opportunity0.0549574626423028NN
address0NN

weight for age score

Label: 1, with a score of: 0.729188688443444
WordScorePoS
age0.112994637345193NN

Label: 3, with a score of: 0.576372129004236
WordScorePoS
age0.0893142758861673NN

age months Africa Asia Latin America and Caribbean Source Shrimpton and others

Label: 1, with a score of: 0.714467046199351
WordScorePoS
age0.112994637345193NN
africa0IN
asia0IN
source0.0269969049497485NN

Neonates and infants up to about six to nine months of age acquire immunity from their mothers which often prevents ARIs Sato and others

Label: 3, with a score of: 0.797233705401774
WordScorePoS
infant0NN
age0.0893142758861673NN
acquire0.0307735781890304NN
mother0.162963395911232NN
prevent0VB

Label: 2, with a score of: 0.351168513364433
WordScorePoS
infant0.0583416713841148NN
age0.0365427838531249NN
acquire0NN
mother0NN
prevent0.0297950283197006VB

Label: 1, with a score of: 0.318257324161461
WordScorePoS
infant0NN
age0.112994637345193NN
acquire0NN
mother0NN
prevent0VB

The immaturity of the infants immune responses Marodi Nair and others Wilson however helps explain why early exposure to diarrheal pathogens especially in early infancy is so critical in the development of malnutrition

Label: 1, with a score of: 0.729702755315481
WordScorePoS
infant0NN
response0NN
help0NN
exposure0.120266261535276NN
critical0JJ
development0.0164833460638534NN
malnutrition0.0736315832425121NN

Thus the same infections that cause disease in the developed world only among those with impaired immune systems for example AIDS patients lead to diarrhea and growth faltering in infants in developing countries Checkley and others Molbak and others

Label: 3, with a score of: 0.756660951028419
WordScorePoS
infection0.122222546933424NN
disease0.215415047323213NN
develop0VB
world0.00087176582269799NN
system0NN
aid0.123094312756122NN
lead0.025518364538905NN
growth0NN
infant0NN
country0NN

Label: 8, with a score of: 0.499368342173958
WordScorePoS
infection0NN
disease0NN
develop0VB
world0.00172202218602071NN
system0NN
aid0.0607878664258118NN
lead0.0504071033101074NN
growth0.208565600657229NN
infant0NN
country0NN

Breastfeeding is considered an effective means of protecting infants from diarrheal diseases Dai and Walker VanDerslice Popkin and Briscoe

Label: 3, with a score of: 0.734113702553466
WordScorePoS
effective0.00914534810831654JJ
means0NNS
protect0.00914534810831654VB
infant0NN
disease0.215415047323213NN

The stress and fever caused by disease increase the child food requirements while also reducing the intake and absorption of nutrients

Label: 2, with a score of: 0.561608868662926
WordScorePoS
stress0NN
cause0NN
disease0NN
increase0.0128868286091919NN
child0.0546336178945768NN
food0.292342270824999NN
reduce0.00799614078871077VB
intake0NN
nutrient0NN

Label: 3, with a score of: 0.539517946625089
WordScorePoS
stress0NN
cause0NN
disease0.215415047323213NN
increase0.0143984997539974NN
child0.10682408961305NN
food0NN
reduce0.01675146888405VB
intake0NN
nutrient0NN

Label: 12, with a score of: 0.416852295899069
WordScorePoS
stress0.0542519672965169NN
cause0NN
disease0NN
increase0.00958677785775002NN
child0NN
food0.186896403054502NN
reduce0.022306853314744VB
intake0NN
nutrient0NN

Proper feeding practices during diarrheal episodes are critical for child health and recovery

Label: 3, with a score of: 0.681432717003976
WordScorePoS
proper0JJ
practice0NN
critical0JJ
child0.10682408961305NN
health0.191387734041787NN
recovery0NN

Label: 16, with a score of: 0.383630513912363
WordScorePoS
proper0JJ
practice0NN
critical0JJ
child0.0603953832457135NN
health0NN
recovery0.107490825192354NN

Label: 2, with a score of: 0.315739303633934
WordScorePoS
proper0.0583416713841148JJ
practice0.0252000451111224NN
critical0JJ
child0.0546336178945768NN
health0NN
recovery0NN

In most cultures the common practice is to restrict food from sick children often for too long time Brown

Label: 2, with a score of: 0.655629245795637
WordScorePoS
culture0NN
common0JJ
practice0.0252000451111224NN
food0.292342270824999NN
child0.0546336178945768NN
time0.0182713919265625NN

Label: 12, with a score of: 0.506932802524904
WordScorePoS
culture0.0277064208763707NN
common0JJ
practice0.0703006268489394NN
food0.186896403054502NN
child0NN
time0.0169905820958638NN

Label: 3, with a score of: 0.304149620799153
WordScorePoS
culture0NN
common0.0615471563780609JJ
practice0NN
food0NN
child0.10682408961305NN
time0.0127591822694525NN

Only in recent years has the medical profession emphasized the need for continuous feeding during diarrheal episodes Brown

Label: 0, with a score of: 1

Reducing the level of environmental contamination similarly reduces the risk of diarrhea VanDerslice Popkin and Briscoe

Label: 11, with a score of: 0.495291570390816
WordScorePoS
reduce0.0200483235258943VB
level0.00692515656684925NN
environmental0.0537696560159885JJ
contamination0NN
risk0.0631828116343571NN

Label: 3, with a score of: 0.436873537768093
WordScorePoS
reduce0.01675146888405VB
level0NN
environmental0JJ
contamination0.0407408489778079NN
risk0.0703902516159815NN

Label: 1, with a score of: 0.424417370541544
WordScorePoS
reduce0.0164833460638534VB
level0.0113874611101829NN
environmental0.0442083771593746JJ
contamination0NN
risk0.0519476926891779NN

Good sanitation practices protect infants by creating barriers to keep pathogens out of their environment

Label: 6, with a score of: 0.682264398878087
WordScorePoS
sanitation0.334686906581616NN
practice0NN
protect0.0153390539205676VB
infant0NN
create0VB
barrier0NN
environment0NN

Label: 12, with a score of: 0.361927724227147
WordScorePoS
sanitation0NN
practice0.0703006268489394NN
protect0.0121782716594324VB
infant0NN
create0.0234335422829798VB
barrier0NN
environment0.079769385071606NN

Label: 9, with a score of: 0.360040503249265
WordScorePoS
sanitation0.0737171311497939NN
practice0NN
protect0VB
infant0NN
create0.0520080474473126VB
barrier0.0368585655748969NN
environment0.0221298700466866NN

These practices ENVIRONMENTAL HEALTH AND CHILD SURVIVAL include properly disposing of excreta to isolate human wastes improving water supplies to protect drinking water from fecal contamination and hand washing and personal hygiene to reduce the transmission of enteric pathogens in the home VanDerslice Popkin and Briscoe

Label: 6, with a score of: 0.8238666238335
WordScorePoS
practice0NN
environmental0JJ
health0NN
child0.0255958462813622NN
include0VB
human0.0127979231406811JJ
waste0NN
improve0.0511916925627245VB
water0.556409482163189NN
supplies0NNS
protect0.0153390539205676VB
drinking0.206460189193271NN
contamination0NN
personal0JJ
hygiene0.136665345449673NN
reduce0.00936547854413134VB

Label: 12, with a score of: 0.40679900467337
WordScorePoS
practice0.0703006268489394NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
include0VB
human0.0101607690729067JJ
waste0.138532104381853NN
improve0VB
water0.186896403054502NN
supplies0NNS
protect0.0121782716594324VB
drinking0NN
contamination0NN
personal0.0542519672965169JJ
hygiene0NN
reduce0.022306853314744VB

Label: 3, with a score of: 0.231595029445711
WordScorePoS
practice0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
include0VB
human0JJ
waste0NN
improve0VB
water0.0382775468083574NN
supplies0NNS
protect0.00914534810831654VB
drinking0NN
contamination0.0407408489778079NN
personal0JJ
hygiene0NN
reduce0.01675146888405VB

Analysis of data in Bangladesh Malaysia and the Philippines has provided evidence that lack of breastfeeding and poor environmental sanitation have pernicious synergistic effect on infant mortality Habicht DaVanzo and Butz Pelletier

Label: 6, with a score of: 0.595791896195249
WordScorePoS
datum0NN
evidence0NN
lack0.0214003646985842NN
poor0.0642010940957526JJ
environmental0JJ
sanitation0.334686906581616NN
effect0NN
infant0NN
mortality0NN

Label: 3, with a score of: 0.427974570113676
WordScorePoS
datum0NN
evidence0NN
lack0NN
poor0JJ
environmental0JJ
sanitation0.0249430985430622NN
effect0NN
infant0NN
mortality0.276962203701274NN

Label: 1, with a score of: 0.383026475641486
WordScorePoS
datum0NN
evidence0NN
lack0.0753297582301286NN
poor0.150659516460257JJ
environmental0.0442083771593746JJ
sanitation0NN
effect0NN
infant0NN
mortality0NN

Label: 10, with a score of: 0.286418826042341
WordScorePoS
datum0NN
evidence0.12939607756667NN
lack0NN
poor0JJ
environmental0.0237821918091848JJ
sanitation0NN
effect0NN
infant0NN
mortality0.0488696285210061NN

Label: 9, with a score of: 0.344979947964083
WordScorePoS
datum0.0454743001434393NN
evidence0NN
lack0.0565629593551219NN
poor0JJ
environmental0.0221298700466866JJ
sanitation0.0737171311497939NN
effect0.0454743001434393NN
infant0NN
mortality0NN

The protective effect provided by good quality drinking water and improved community sanitation is greatest for nonbreastfed infants and completely weaned infants VanDerslice Popkin and Briscoe

Label: 6, with a score of: 0.943932805756388
WordScorePoS
effect0NN
quality0.0255958462813622NN
drinking0.206460189193271NN
water0.556409482163189NN
improve0.0511916925627245VB
community0.0214003646985842NN
sanitation0.334686906581616NN
infant0NN

Label: 12, with a score of: 0.176992479369319
WordScorePoS
effect0NN
quality0.0203215381458133NN
drinking0NN
water0.186896403054502NN
improve0VB
community0.0169905820958638NN
sanitation0NN
infant0NN

For the latter reducing exposures especially foodborne exposures remains important

Label: 1, with a score of: 0.953139287479605
WordScorePoS
reduce0.0164833460638534VB
exposure0.120266261535276NN
remains0NNS

Strategies for reducing exposures include improvements in choice of supplemental foods better preparation practices and storage methods and better personal hygiene VanDerslice Popkin and Briscoe

Label: 12, with a score of: 0.62155303672428
WordScorePoS
strategy0NN
reduce0.022306853314744VB
exposure0NN
include0VB
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food0.186896403054502NN
practice0.0703006268489394NN
personal0.0542519672965169JJ
hygiene0NN

Label: 2, with a score of: 0.539953279691836
WordScorePoS
strategy0NN
reduce0.00799614078871077VB
exposure0NN
include0VB
improvement0NN
choice0NN
food0.292342270824999NN
practice0.0252000451111224NN
personal0JJ
hygiene0NN

Label: 6, with a score of: 0.363320311576299
WordScorePoS
strategy0NN
reduce0.00936547854413134VB
exposure0NN
include0VB
improvement0NN
choice0.0516150472983178NN
food0.0214003646985842NN
practice0NN
personal0JJ
hygiene0.136665345449673NN

Label: 1, with a score of: 0.300145360212755
WordScorePoS
strategy0.0442083771593746NN
reduce0.0164833460638534VB
exposure0.120266261535276NN
include0VB
improvement0NN
choice0NN
food0NN
practice0NN
personal0JJ
hygiene0NN

Clean Environments Healthy Children In early childhood two to five years of age the growth faltering effects of repeated disease episodes are considered largely reversible in contrast to the irreversibility of such effects in early infancy

Label: 3, with a score of: 0.632512333701264
WordScorePoS
clean0.020806307400253JJ
environment0NN
healthy0.0615471563780609JJ
child0.10682408961305NN
childhood0NN
age0.0893142758861673NN
growth0NN
effect0NN
disease0.215415047323213NN

Label: 8, with a score of: 0.433045811973542
WordScorePoS
clean0JJ
environment0.0591643007226199NN
healthy0JJ
child0.0452169560888236NN
childhood0NN
age0.0252035516550537NN
growth0.208565600657229NN
effect0NN
disease0NN

Label: 7, with a score of: 0.160119921506869
WordScorePoS
clean0.125032076213024JJ
environment0NN
healthy0JJ
child0NN
childhood0NN
age0NN
growth0NN
effect0NN
disease0NN

Still the environmental risk factors associated with poor access to water improper sanitation and bad household and community hygiene remain threat especially given the child increased mobility walking and associated ever increasing peri household activities

Label: 6, with a score of: 0.827898289395651
WordScorePoS
environmental0JJ
risk0NN
poor0.0642010940957526JJ
access0.00731085509381114NN
water0.556409482163189NN
sanitation0.334686906581616NN
bad0.0683326727248364JJ
household0NN
community0.0214003646985842NN
hygiene0.136665345449673NN
remain0VB
threat0NN
child0.0255958462813622NN
increase0.00905621749519576NN
mobility0NN
perus0NN
activity0.0502364757923669NN

Label: 12, with a score of: 0.290361636851438
WordScorePoS
environmental0.0598270388037045JJ
risk0NN
poor0.0339811641917276JJ
access0.00232174891244877NN
water0.186896403054502NN
sanitation0NN
bad0JJ
household0.0554128417527413NN
community0.0169905820958638NN
hygiene0NN
remain0VB
threat0NN
child0NN
increase0.00958677785775002NN
mobility0NN
perus0NN
activity0.0199423462679015NN

Label: 1, with a score of: 0.191663724092284
WordScorePoS
environmental0.0442083771593746JJ
risk0.0519476926891779NN
poor0.150659516460257JJ
access0.00514687440545096NN
water0NN
sanitation0NN
bad0JJ
household0NN
community0NN
hygiene0NN
remain0VB
threat0NN
child0.0450489732120807NN
increase0NN
mobility0NN
perus0NN
activity0NN

Action should be taken at both the household level and the community level â–  Household level

Label: 13, with a score of: 0.475806654066789
WordScorePoS
action0.0369195714265843NN
household0NN
level0.0415277415054218NN
community0.0343390275626203NN

Label: 5, with a score of: 0.451529330949394
WordScorePoS
action0.0409315617631NN
household0.0465610847355851NN
level0.0172651853471334NN
community0NN

Label: 12, with a score of: 0.377563903457017
WordScorePoS
action0.0121782716594324NN
household0.0554128417527413NN
level0.00513687014008325NN
community0.0169905820958638NN

In the late infancy and toddler periods hand washing practices proper disposal of children feces and safe storage of milk and weaning foods are critical activities to cut diarrheal transmission

Label: 2, with a score of: 0.721373267140773
WordScorePoS
period0.0440683498519077NN
practice0.0252000451111224NN
proper0.0583416713841148JJ
child0.0546336178945768NN
safe0.0182713919265625JJ
food0.292342270824999NN
critical0JJ
activity0NN
cut0NN

Label: 12, with a score of: 0.46561593078603
WordScorePoS
period0.0409791940864438NN
practice0.0703006268489394NN
proper0JJ
child0NN
safe0JJ
food0.186896403054502NN
critical0JJ
activity0.0199423462679015NN
cut0NN

In addition with increased mobility of the child from crawling on the floor to walking and running addressing general household hygiene in terms of surfaces including bedclothes and floors becomes crucial as do cleaner yards outside soil helminths or parasites caused by lack of sanitation or animal wastes from domestic animals Cairncross and others

Label: 6, with a score of: 0.486469011088327
WordScorePoS
addition0NN
increase0.00905621749519576NN
mobility0NN
child0.0255958462813622NN
floor0NN
address0NN
household0NN
hygiene0.136665345449673NN
term0NN
surface0NN
include0VB
crucial0JJ
cleaner0JJR
soil0NN
cause0NN
lack0.0214003646985842NN
sanitation0.334686906581616NN
animal0NN
waste0NN
domestic0JJ

Label: 12, with a score of: 0.23884601612513
WordScorePoS
addition0NN
increase0.00958677785775002NN
mobility0NN
child0NN
floor0NN
address0NN
household0.0554128417527413NN
hygiene0NN
term0NN
surface0NN
include0VB
crucial0JJ
cleaner0JJR
soil0.0554128417527413NN
cause0NN
lack0NN
sanitation0NN
animal0NN
waste0.138532104381853NN
domestic0JJ

Label: 17, with a score of: 0.200641433514162
WordScorePoS
addition0NN
increase0.00432344066632653NN
mobility0NN
child0NN
floor0NN
address0NN
household0NN
hygiene0NN
term0.149793392961411NN
surface0NN
include0VB
crucial0JJ
cleaner0JJR
soil0NN
cause0NN
lack0NN
sanitation0NN
animal0NN
waste0NN
domestic0.0634082886861185JJ

Label: 7, with a score of: 0.400662975421891
WordScorePoS
addition0NN
increase0.0162235147372888NN
mobility0NN
child0NN
floor0NN
address0NN
household0NN
hygiene0NN
term0.0749457204978913NN
surface0NN
include0VB
crucial0JJ
cleaner0.0924643738905717JJR
soil0NN
cause0NN
lack0.0383371018038178NN
sanitation0NN
animal0.0749457204978913NN
waste0.0625160381065121NN
domestic0JJ

â–  Community level

Label: 13, with a score of: 0.643648085214033
WordScorePoS
community0.0343390275626203NN
level0.0415277415054218NN

Label: 16, with a score of: 0.518086928866674
WordScorePoS
community0NN
level0.0610668815653026NN

Community action and control of the public domain can be seen as an important step to enable improved household and personal hygienic practices the private domain

Label: 5, with a score of: 0.631827861629864
WordScorePoS
community0NN
action0.0409315617631NN
control0.0465610847355851NN
public0.0727679293221751NN
enable0.0465610847355851VB
improve0VB
household0.0465610847355851NN
personal0JJ
practice0.0393804437159645NN
private0.0558185411034276JJ

Label: 12, with a score of: 0.431393901390678
WordScorePoS
community0.0169905820958638NN
action0.0121782716594324NN
control0NN
public0.028867295332595NN
enable0VB
improve0VB
household0.0554128417527413NN
personal0.0542519672965169JJ
practice0.0703006268489394NN
private0JJ

Label: 17, with a score of: 0.377422431634079
WordScorePoS
community0NN
action0.0109843026967392NN
control0NN
public0.0390556786919513NN
enable0.0499801157438617VB
improve0.0183291958415182VB
household0NN
personal0JJ
practice0NN
private0.0898760357768464JJ

Both are needed but in some cases for example with hookworms collective sanitation efforts are key to success Cairncross and others

Label: 6, with a score of: 0.902711541202063
WordScorePoS
sanitation0.334686906581616NN
effort0NN
key0NN

In addition young children will benefit from indoor residual spraying or other personal level protection against malaria even if the problem is not addressed collectively

Label: 3, with a score of: 0.673784894397023
WordScorePoS
addition0NN
child0.10682408961305NN
benefit0NN
personal0JJ
level0NN
protection0.020806307400253NN
malaria0.20370424488904NN
address0NN

Label: 1, with a score of: 0.364566619682103
WordScorePoS
addition0NN
child0.0450489732120807NN
benefit0NN
personal0JJ
level0.0113874611101829NN
protection0.122839698738001NN
malaria0NN
address0NN

Label: 10, with a score of: 0.315230179788831
WordScorePoS
addition0NN
child0.0242343960710022NN
benefit0NN
personal0JJ
level0NN
protection0.0660824365173543NN
malaria0NN
address0.064698038783335NN

Averting Cognition and Learning Impacts Cognitive function in children reflecting an ability to learn is affected by environmental and health related factors Berkman and others

Label: 4, with a score of: 0.677419899152257
WordScorePoS
avert0VB
learn0.244520809605025VB
impact0NN
function0NN
child0.076326555629389NN
reflect0VB
ability0NN
affect0.0125233923809486VB
environmental0JJ
health0NN
related0JJ

Label: 3, with a score of: 0.46710042994918
WordScorePoS
avert0.0814816979556159VB
learn0VB
impact0NN
function0NN
child0.10682408961305NN
reflect0VB
ability0NN
affect0.00625975725959118VB
environmental0JJ
health0.191387734041787NN
related0.0125195145191824JJ

Label: 12, with a score of: 0.336869367947258
WordScorePoS
avert0VB
learn0VB
impact0.0866018859977851NN
function0NN
child0NN
reflect0.0409791940864438VB
ability0.0409791940864438NN
affect0.0166714319731757VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
related0.00833571598658786JJ

Risk factors ENVIRONMENTAL HEALTH MALNUTRITION AND CHILD HEALTH that interfere with cognition are especially important in the first two years of child life which marks period of rapid growth and development Berkman and others

Label: 3, with a score of: 0.665354484397173
WordScorePoS
risk0.0703902516159815NN
environmental0JJ
health0.191387734041787NN
malnutrition0NN
child0.10682408961305NN
life0.0250390290383647NN
period0NN
rapid0.020806307400253JJ
growth0NN
development0.00837573444202498NN

Label: 8, with a score of: 0.319706854817128
WordScorePoS
risk0NN
environmental0.0295821503613099JJ
health0NN
malnutrition0NN
child0.0452169560888236NN
life0.0123650647908625NN
period0NN
rapid0JJ
growth0.208565600657229NN
development0.0055149369084567NN

Label: 1, with a score of: 0.320014753630574
WordScorePoS
risk0.0519476926891779NN
environmental0.0442083771593746JJ
health0NN
malnutrition0.0736315832425121NN
child0.0450489732120807NN
life0.0184786920895884NN
period0NN
rapid0JJ
growth0.0519476926891779NN
development0.0164833460638534NN

In early childhood diseases attributed to environmental factors such as diarrhea and helminth infections also have the potential to affect child later cognitive functions

Label: 3, with a score of: 0.794333578149658
WordScorePoS
childhood0NN
disease0.215415047323213NN
environmental0JJ
infection0.122222546933424NN
potential0NN
affect0.00625975725959118VB
child0.10682408961305NN
function0NN

Label: 4, with a score of: 0.300230211645333
WordScorePoS
childhood0.0815069365350084NN
disease0NN
environmental0JJ
infection0NN
potential0NN
affect0.0125233923809486VB
child0.076326555629389NN
function0NN

Over the past several years studies have begun to investigate the impact of diarrheal illness and helminth infections during early childhood on verbal fluency cognitive function and school performance

Label: 4, with a score of: 0.739092227576194
WordScorePoS
study0NN
impact0NN
illness0NN
infection0NN
childhood0.0815069365350084NN
function0NN
school0.208127520578185NN
performance0NN

Label: 3, with a score of: 0.415851692847242
WordScorePoS
study0NN
impact0NN
illness0.0407408489778079NN
infection0.122222546933424NN
childhood0NN
function0NN
school0NN
performance0NN

Several studies of children in Brazil and Peru have investigated the impact of diarrheal illness in the first two years of life and subsequent deficits in cognitive function as well as school performance

Label: 4, with a score of: 0.638556879444509
WordScorePoS
study0NN
child0.076326555629389NN
impact0NN
illness0NN
life0.0125233923809486NN
function0NN
school0.208127520578185NN
performance0NN

Label: 3, with a score of: 0.371130683660616
WordScorePoS
study0NN
child0.10682408961305NN
impact0NN
illness0.0407408489778079NN
life0.0250390290383647NN
function0NN
school0NN
performance0NN

Among Brazilian children the incidence of diarrheal illnesses in infancy was found to be associated with impaired cognitive performance to years later Guerrant and others Niehaus and others as well as with disproportionate reduction in verbal fluency to years later Patrick and others

Label: 3, with a score of: 0.706606550362444
WordScorePoS
child0.10682408961305NN
incidence0.0407408489778079NN
illness0.0407408489778079NN
performance0NN
reduction0.0149758277542848NN

However one large study in Peru that controlled for confounders saw no independent association with IQ at nine years of age Walker and others

Label: 1, with a score of: 0.749931603877289
WordScorePoS
study0NN
control0.0614198493690006NN
age0.112994637345193NN

Label: 3, with a score of: 0.473486504473756
WordScorePoS
study0NN
control0.020806307400253NN
age0.0893142758861673NN

The number of overt episodes of diarrhea has also been associated with indicators of school performance Lorntz and others

Label: 4, with a score of: 0.849140179985077
WordScorePoS
school0.208127520578185NN
performance0NN

Label: 5, with a score of: 0.379929456352916
WordScorePoS
school0.0931221694711702NN
performance0NN

Helminth infections have the highest prevalence and intensity in school age children and analyses of schoolchildren in Jamaica and Kenya have shown the positive effects of treatment on cognition function Guerrant and others

Label: 4, with a score of: 0.480548904997527
WordScorePoS
infection0NN
prevalence0NN
intensity0NN
school0.208127520578185NN
age0.0255262687343935NN
child0.076326555629389NN
positive0JJ
effect0NN
treatment0NN
function0NN

Label: 3, with a score of: 0.653464989791843
WordScorePoS
infection0.122222546933424NN
prevalence0.0407408489778079NN
intensity0NN
school0NN
age0.0893142758861673NN
child0.10682408961305NN
positive0JJ
effect0NN
treatment0.0624189222007589NN
function0NN

Label: 2, with a score of: 0.324171143194423
WordScorePoS
infection0NN
prevalence0NN
intensity0NN
school0.0297950283197006NN
age0.0365427838531249NN
child0.0546336178945768NN
positive0JJ
effect0.0440683498519077NN
treatment0NN
function0.0440683498519077NN

Only few studies show the effect of helminths on development in children under five years of age Walker and others

Label: 3, with a score of: 0.53078376104882
WordScorePoS
study0NN
effect0NN
development0.00837573444202498NN
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.452956908430179
WordScorePoS
study0NN
effect0NN
development0.0164833460638534NN
child0.0450489732120807NN
age0.112994637345193NN

Label: 2, with a score of: 0.392511622927869
WordScorePoS
study0NN
effect0.0440683498519077NN
development0.0159922815774215NN
child0.0546336178945768NN
age0.0365427838531249NN

Label: 4, with a score of: 0.33682483551034
WordScorePoS
study0NN
effect0NN
development0.0279277626235394NN
child0.076326555629389NN
age0.0255262687343935NN

In rural Nicaragua the presence of intestinal parasites was associated with poor language performance among children see Walker and others

Label: 2, with a score of: 0.641788585020375
WordScorePoS
rural0.148975141598503JJ
poor0.0548141757796873JJ
performance0NN
child0.0546336178945768NN

Label: 1, with a score of: 0.486038418109867
WordScorePoS
rural0JJ
poor0.150659516460257JJ
performance0NN
child0.0450489732120807NN

Label: 10, with a score of: 0.302919313870269
WordScorePoS
rural0.0330412182586772JJ
poor0JJ
performance0.064698038783335NN
child0.0242343960710022NN

In recent years several new longitudinal studies often enrolling close to participants have investigated the effect of early childhood malnutrition on educational outcomes such as school grade attainment Alderman and others Grantham McGregor and others Maluccio Hoddinott and Behrman learning productivity Behrman and others school dropout or grade repetition Lorntz and others and primary school enrollment Alderman and others Lorntz and others

Label: 4, with a score of: 0.87886249680196
WordScorePoS
study0NN
enrol0.0615662203253227VB
effect0NN
childhood0.0815069365350084NN
malnutrition0NN
educational0JJ
outcome0.0416255041156371NN
school0.208127520578185NN
learn0.244520809605025VB
productivity0NN
primary0.108423939529757JJ

Earlier studies had already consistently shown that an increasing level of stunting has negative effects on the studied variables Grantham McGregor and others

Label: 2, with a score of: 0.732517254476628
WordScorePoS
study0NN
increase0.0128868286091919NN
level0.00552410547653725NN
stunt0.11668334276823NN
effect0.0440683498519077NN

Alderman and others have recently shown how one standard deviation drop in height for age leads to

Label: 1, with a score of: 0.790228365700797
WordScorePoS
standard0NN
height0.120266261535276NN
age0.112994637345193NN
lead0NN

Label: 3, with a score of: 0.389023664950861
WordScorePoS
standard0NN
height0NN
age0.0893142758861673NN
lead0.025518364538905NN

year lower school grade attainment or

Label: 4, with a score of: 0.880363915968638
WordScorePoS
school0.208127520578185NN

Label: 5, with a score of: 0.393899843477631
WordScorePoS
school0.0931221694711702NN

year delayed enrollment

Label: 0, with a score of: 1

For review of these studies see appendix B

Label: 5, with a score of: 0.734737748093731
WordScorePoS
review0.0688661930304451NN
study0NN

Label: 15, with a score of: 0.551953194510211
WordScorePoS
review0NN
study0.0517339898971162NN

Label: 17, with a score of: 0.394345169358172
WordScorePoS
review0.036961556179878NN
study0NN

In addition to diarrheal illness and helminth infections severe or cerebral malaria in children under five years of age is associated with subsequent neurological and cognitive impairments Walker and others

Label: 3, with a score of: 0.909307956141403
WordScorePoS
addition0NN
illness0.0407408489778079NN
infection0.122222546933424NN
malaria0.20370424488904NN
child0.10682408961305NN
age0.0893142758861673NN

Data from study of Kenyan children suggest severe falciparum malaria may be the single most common cause of acquired language disorder in the tropics Carter and Mendis

Label: 3, with a score of: 0.840987841334951
WordScorePoS
datum0NN
study0NN
child0.10682408961305NN
suggest0VB
malaria0.20370424488904NN
single0JJ
common0.0615471563780609JJ
acquire0.0307735781890304NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Key Messages â–  â–  â–  Malnutrition poor environmental conditions and infectious diseases are highly associated geographically and take their heaviest tolls on children under five years of age in Sub Saharan Africa South Asia and certain countries in the Eastern Mediterranean region

Label: 3, with a score of: 0.663845988921953
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
key0NN
malnutrition0NN
poor0JJ
condition0NN
disease0.215415047323213NN
highly0RB
age0.0893142758861673NN
saharan0.0299516555085695JJ
africa0IN
south0RB
asia0IN
country0NN
eastern0.0407408489778079JJ
region0.124837844401518NN

Label: 1, with a score of: 0.545766018838774
WordScorePoS
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
key0NN
malnutrition0.0736315832425121NN
poor0.150659516460257JJ
condition0NN
disease0NN
highly0RB
age0.112994637345193NN
saharan0.0442083771593746JJ
africa0IN
south0RB
asia0IN
country0NN
eastern0JJ
region0.184259548107002NN

Infections and malnutrition operate in vicious cycle to affect child health

Label: 3, with a score of: 0.778909990757134
WordScorePoS
infection0.122222546933424NN
malnutrition0NN
operate0VB
cycle0NN
affect0.00625975725959118VB
child0.10682408961305NN
health0.191387734041787NN

Label: 12, with a score of: 0.389567140484202
WordScorePoS
infection0NN
malnutrition0NN
operate0.0542519672965169VB
cycle0.108503934593034NN
affect0.0166714319731757VB
child0NN
health0.0339811641917276NN

Until recently however the role of infections in the worsening of nutritional status which in turn reduces growth in children was not addressed

Label: 8, with a score of: 0.499542407398858
WordScorePoS
infection0NN
worsen0VB
nutritional0JJ
status0NN
reduce0.0055149369084567VB
growth0.208565600657229NN
child0.0452169560888236NN
address0NN

Label: 10, with a score of: 0.540620957527314
WordScorePoS
infection0NN
worsen0VB
nutritional0JJ
status0.0488696285210061NN
reduce0.0310356414389692VB
growth0.11178243319132NN
child0.0242343960710022NN
address0.064698038783335NN

Label: 3, with a score of: 0.47353553476473
WordScorePoS
infection0.122222546933424NN
worsen0VB
nutritional0JJ
status0NN
reduce0.01675146888405VB
growth0NN
child0.10682408961305NN
address0NN

Over the past several decades several cohort studies have provided strong evidence of how almost all infections influence child nutritional status

Label: 10, with a score of: 0.602226088637655
WordScorePoS
decade0NN
study0NN
strong0.0488696285210061JJ
evidence0.12939607756667NN
infection0NN
influence0NN
child0.0242343960710022NN
nutritional0JJ
status0.0488696285210061NN

Label: 3, with a score of: 0.548744909222046
WordScorePoS
decade0NN
study0NN
strong0JJ
evidence0NN
infection0.122222546933424NN
influence0NN
child0.10682408961305NN
nutritional0JJ
status0NN

The impact of infections on child growth has shown that exposure to environmental health risks in early infancy leads to permanent growth faltering lowered immunity and increased mortality

Label: 3, with a score of: 0.685005271254786
WordScorePoS
impact0NN
infection0.122222546933424NN
child0.10682408961305NN
growth0NN
exposure0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
lead0.025518364538905NN
increase0.0143984997539974NN
mortality0.276962203701274NN

Label: 8, with a score of: 0.465981120603353
WordScorePoS
impact0NN
infection0NN
child0.0452169560888236NN
growth0.208565600657229NN
exposure0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
lead0.0504071033101074NN
increase0.00711043475673939NN
mortality0NN

Label: 1, with a score of: 0.309863767629688
WordScorePoS
impact0NN
infection0NN
child0.0450489732120807NN
growth0.0519476926891779NN
exposure0.120266261535276NN
environmental0.0442083771593746JJ
health0NN
risk0.0519476926891779NN
lead0NN
increase0NN
mortality0NN

Label: 10, with a score of: 0.30856340088774
WordScorePoS
impact0NN
infection0NN
child0.0242343960710022NN
growth0.11178243319132NN
exposure0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN
lead0NN
increase0.00285817158600878NN
mortality0.0488696285210061NN

In the life cycle of child the period from the womb to the age of about two years the so called window of opportunity is critical in terms of environmental health interventions

Label: 3, with a score of: 0.621782818064276
WordScorePoS
life0.0250390290383647NN
cycle0NN
child0.10682408961305NN
period0NN
age0.0893142758861673NN
opportunity0NN
critical0JJ
term0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN

Label: 17, with a score of: 0.277185230731554
WordScorePoS
life0NN
cycle0NN
child0NN
period0NN
age0.0153248097886055NN
opportunity0NN
critical0.036961556179878JJ
term0.149793392961411NN
environmental0JJ
health0NN
intervention0NN

Label: 12, with a score of: 0.368014967833875
WordScorePoS
life0.0250071479597636NN
cycle0.108503934593034NN
child0NN
period0.0409791940864438NN
age0NN
opportunity0NN
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Label: 1, with a score of: 0.302767999801753
WordScorePoS
life0.0184786920895884NN
cycle0NN
child0.0450489732120807NN
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intervention0NN

The infections that adversely affect child growth have also been seen to result in cognition and learning impacts as well as chronic diseases later in life

Label: 3, with a score of: 0.610563119739056
WordScorePoS
infection0.122222546933424NN
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Label: 4, with a score of: 0.443900291352116
WordScorePoS
infection0NN
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Label: 8, with a score of: 0.341558267880996
WordScorePoS
infection0NN
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child0.0452169560888236NN
growth0.208565600657229NN
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life0.0123650647908625NN

Label: 6, with a score of: 0.390994944394679
WordScorePoS
infection0NN
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Note The World Health Organization defines liters per capita per day as the amount of water required to meet all consumption and hygiene needs

Label: 6, with a score of: 0.618682700387248
WordScorePoS
world0.00438651305628668NN
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Label: 12, with a score of: 0.542751303031014
WordScorePoS
world0.00464349782489754NN
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Label: 8, with a score of: 0.317103899215888
WordScorePoS
world0.00172202218602071NN
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Label: 1, with a score of: 0.275507015790254
WordScorePoS
world0.00257343720272548NN
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Label: 3, with a score of: 0.270043633929649
WordScorePoS
world0.00087176582269799NN
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Additional information on lower service levels and potential effects on health are described in Howard and Bartram

Label: 3, with a score of: 0.532286220664869
WordScorePoS
additional0JJ
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Label: 9, with a score of: 0.533499873081439
WordScorePoS
additional0JJ
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Label: 2, with a score of: 0.306154204394178
WordScorePoS
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H P E How Environmental Health Supplements Other Child Survival Strategies THE BIGGEST EFFECTS ON MORTALITY can be achieved by simultaneously improving health status and nutritional status of high mortality populations Pelletier

Label: 3, with a score of: 0.841202009986027
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.349276371313941
WordScorePoS
environmental0.0237821918091848JJ
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However the current child survival strategies in developing countries focus mostly on case management and treatment

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WordScorePoS
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Label: 11, with a score of: 0.36073259672842
WordScorePoS
current0JJ
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Label: 8, with a score of: 0.313254818573335
WordScorePoS
current0JJ
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From the health sector perspective primary prevention comprises vaccinations micronutrient supplementation promotion of breastfeeding and measures to decrease low birth weight including birth spacing Murphy Stanton and Galbraith see figure

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WordScorePoS
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Label: 5, with a score of: 0.444911314269177
WordScorePoS
health0.0571058915334038NN
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These strategies all are intended to increase the ability of the host to resist or reduce infection after exposure has occurred but they do not attempt to reduce exposure to the environmental determinants of ill health which constitute another aspect of primary prevention

Label: 3, with a score of: 0.687849873114732
WordScorePoS
strategy0.0149758277542848NN
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Label: 1, with a score of: 0.459989644681193
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Label: 12, with a score of: 0.344368551939406
WordScorePoS
strategy0NN
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Additional activities relating to environmental health sanitation clean water and vector control are largely ignored because they fall outside of the current health sector mandate see figure

Label: 6, with a score of: 0.74015421477242
WordScorePoS
additional0JJ
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Label: 3, with a score of: 0.453087953204387
WordScorePoS
additional0JJ
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Label: 12, with a score of: 0.28551285200106
WordScorePoS
additional0JJ
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Label: 7, with a score of: 0.0927628056416234
WordScorePoS
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even though environmental health legislation is often in place and such activities are known to be extremely effective

Label: 3, with a score of: 0.565590813681891
WordScorePoS
environmental0JJ
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Label: 5, with a score of: 0.376218619851416
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.334052791414321
WordScorePoS
environmental0.0237821918091848JJ
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Label: 16, with a score of: 0.321722175542451
WordScorePoS
environmental0JJ
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Label: 12, with a score of: 0.320826194983897
WordScorePoS
environmental0.0598270388037045JJ
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Within the World Bank new Health Nutrition and Population strategy the Multisectoral Constraints Assessment attempts to address this issue by looking at the multisectoral determinants of health outcomes including those from the environmental and infrastructure sectors

Label: 9, with a score of: 0.51198919338483
WordScorePoS
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Label: 3, with a score of: 0.493048064344571
WordScorePoS
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Label: 2, with a score of: 0.396334848292405
WordScorePoS
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Label: 5, with a score of: 0.316902181805289
WordScorePoS
world0.00585260443759492NN
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The new strategy focus on strengthening health systems including disease surveillance systems will also help ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE

Label: 3, with a score of: 0.787329765138773
WordScorePoS
strategy0.0149758277542848NN
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Range of Preventive Activities in Child Survival traditional child survival prevention sanitation clean water reduction of air pollution vector control household and community hygiene health immunization breastfeeding food supplementation micronutrients birth spacing exposure disease diagnosis treatment case management death Source Adapted from Favin Yacoob and Bendahmane figure

Label: 6, with a score of: 0.659400883800212
WordScorePoS
range0NN
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Label: 3, with a score of: 0.548993256166563
WordScorePoS
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Label: 12, with a score of: 0.288966745461347
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Label: 2, with a score of: 0.228148333871602
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Label: 7, with a score of: 0.0818389230459292
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better track environment related infections and exposures

Label: 1, with a score of: 0.576483860383137
WordScorePoS
environment0NN
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Label: 3, with a score of: 0.559851884431061
WordScorePoS
environment0NN
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Label: 12, with a score of: 0.36607579195134
WordScorePoS
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Given the evidence showing how environmental risks and subsequent infections affect child malnutrition correcting the current neglect of environmental health in child survival and child health strategies in developing countries becomes even more imperative

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WordScorePoS
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Label: 10, with a score of: 0.256129696358174
WordScorePoS
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Label: 1, with a score of: 0.318954002361666
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This chapter highlights how appropriate environmental health actions can be an important complement and supplement to other existing strategies addressing child health

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WordScorePoS
environmental0JJ
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Adding Value to Health Systems Health system frameworks are designed around improving case management of childhood illnesses

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Label: 11, with a score of: 0.346986685786629
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Through broad frameworks such as Integrated Management of Childhood Illness efforts are being made to strengthen case management to benefit from synergies across vertical programs and to capitalize on externalities in health care delivery Mason and others

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WordScorePoS
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Label: 11, with a score of: 0.411146335410984
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Label: 5, with a score of: 0.300833251559963
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Nevertheless several areas where case management through health systems is not enough in the case of childhood illnesses such as diarrhea acute respiratory infections and helminth infections for example call for better primary prevention of environmental risks see table

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for description of how environmental health can supplement the activities of the health sector

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Label: 5, with a score of: 0.329504850707098
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Label: 12, with a score of: 0.316819589866013
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With the current case management strategies of child survival programs several issues limit the effectiveness of these interventions â–  First is the safety of administering drugs for parasitic infections during pregnancy

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WordScorePoS
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Where possible priority should be given to treating or preventing TABLE

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Label: 16, with a score of: 0.421252199763113
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Label: 14, with a score of: 0.416964069960455
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Label: 12, with a score of: 0.314462789174914
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priority0.0409791940864438NN
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Role of Environmental Health in Supplementing Health System Strategies Cause of Death Neonatal causes omitting sepsis and diarrhea but including neonatal tetanus Main Strategies Health Systems Main Limitations Evidence based prenatal care tetanus toxoid important Counseling and professional help during and after delivery Lack of professional obstetric and prenatal care capacity Role of Environmental Health Because of malaria and Acute lower respiratory infections ALRIs Improved case management Antibiotic resistance Diarrhea including neonatal diarrhea Oral and intravenous Low compliance with oral rehydration therapy Appropriate breastfeeding practices Micronutrient supplementation rehydration therapy Diarrhea incidence unaltered but chronic and bloody diarrhea emerge as problem in an increasing proportion of the remaining deaths Inappropriate use of antibiotics and emerging anthelminth resistance hookworms role is potentially very large in prenatal period which could ease pressure on scarce obstetric capacity

Label: 3, with a score of: 0.845379995011811
WordScorePoS
environmental0JJ
health0.191387734041787NN
system0NN
strategy0.0149758277542848NN
death0.193573191943949NN
neonatal0.0407408489778079JJ
include0VB
evidence0NN
base0.0149758277542848NN
care0.104031537001265NN
lack0NN
capacity0.00625975725959118NN
malaria0.20370424488904NN
infection0.122222546933424NN
improve0VB
management0.0127591822694525NN
therapy0.0407408489778079NN
practice0NN
incidence0.0407408489778079NN
chronic0JJ
emerge0.0407408489778079VB
increase0.0143984997539974NN
proportion0.025518364538905NN
remain0VB
potentially0RB
period0NN
pressure0NN
scarce0JJ

Label: 10, with a score of: 0.167897666241678
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
system0NN
strategy0NN
death0NN
neonatal0JJ
include0VB
evidence0.12939607756667NN
base0NN
care0NN
lack0NN
capacity0NN
malaria0NN
infection0NN
improve0.0121171980355011VB
management0NN
therapy0NN
practice0.02794560829783NN
incidence0NN
chronic0JJ
emerge0VB
increase0.00285817158600878NN
proportion0NN
remain0.0396106020715138VB
potentially0RB
period0NN
pressure0NN
scarce0JJ

Neonatal tetanus control policy may rely mainly on clean delivery that is on hygiene

Label: 7, with a score of: 0.586859736764135
WordScorePoS
neonatal0JJ
control0NN
policy0NN
rely0.0749457204978913VB
clean0.125032076213024JJ
hygiene0NN

Label: 6, with a score of: 0.503472296048704
WordScorePoS
neonatal0JJ
control0NN
policy0NN
rely0VB
clean0.0348974218717993JJ
hygiene0.136665345449673NN

Label: 1, with a score of: 0.312446012613311
WordScorePoS
neonatal0JJ
control0.0614198493690006NN
policy0.0450489732120807NN
rely0VB
clean0JJ
hygiene0NN

Role is large through indoor air pollution mitigation and becomes greater when the effects through malnutrition are considered

Label: 11, with a score of: 0.493841124061215
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN
mitigation0.055245183797332NN
effect0NN
malnutrition0NN

Label: 6, with a score of: 0.40110236305961
WordScorePoS
air0NN
pollution0.0590310971343993NN
mitigation0NN
effect0NN
malnutrition0.041835863322702NN

Label: 14, with a score of: 0.382160639634879
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN
mitigation0NN
effect0NN
malnutrition0NN

Label: 13, with a score of: 0.329343756023459
WordScorePoS
air0NN
pollution0NN
mitigation0.0828215106044499NN
effect0NN
malnutrition0NN

There is increasing reason to believe that hygiene may play role in preventing ALRIs

Label: 6, with a score of: 0.785005992088502
WordScorePoS
increase0.00905621749519576NN
hygiene0.136665345449673NN
prevent0VB

Role in primary prevention of diarrhea is very large through improved water and sanitation facilities and improved hygienic practices

Label: 6, with a score of: 0.893524127760416
WordScorePoS
primary0JJ
prevention0NN
improve0.0511916925627245VB
water0.556409482163189NN
sanitation0.334686906581616NN
facility0NN
practice0NN

Label: 12, with a score of: 0.268176220056848
WordScorePoS
primary0JJ
prevention0.0409791940864438NN
improve0VB
water0.186896403054502NN
sanitation0NN
facility0NN
practice0.0703006268489394NN

continued TABLE

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Role of Environmental Health in Supplementing Health System Strategies continued Cause of Death Main Strategies Health Systems Main Limitations Role of Environmental Health Relatively low about efficacy Neonatal sepsis Malaria Antibiotic therapy Case finding and case management Bednets Indoor residual spraying of micronutrient supplementation especially with rampant infections Breastfeeding by HIV positive mothers Antibiotic resistance and lack of access especially in rural areas to hospitals Antimalarial resistance Low efficacy of bednets Compliance issues leading to retreatment costs Clean delivery in household settings is augmented

Label: 3, with a score of: 0.882463447259996
WordScorePoS
environmental0JJ
health0.191387734041787NN
system0NN
strategy0.0149758277542848NN
continue0VB
death0.193573191943949NN
neonatal0.0407408489778079JJ
malaria0.20370424488904NN
therapy0.0407408489778079NN
management0.0127591822694525NN
infection0.122222546933424NN
hiv0.448149338755887NN
positive0JJ
mother0.162963395911232NN
lack0NN
access0.00610236075888593NN
rural0JJ
issue0.0249430985430622NN
lead0.025518364538905NN
cost0NN
clean0.020806307400253JJ
household0NN
setting0.0407408489778079VBG

Label: 2, with a score of: 0.149656212503318
WordScorePoS
environmental0JJ
health0NN
system0.0756001353333673NN
strategy0NN
continue0VB
death0.0252000451111224NN
neonatal0JJ
malaria0NN
therapy0NN
management0NN
infection0NN
hiv0NN
positive0JJ
mother0NN
lack0NN
access0.00749031153171887NN
rural0.148975141598503JJ
issue0NN
lead0NN
cost0NN
clean0JJ
household0.0297950283197006NN
setting0VBG

Label: 7, with a score of: 0.0897219246651043
WordScorePoS
environmental0JJ
health0NN
system0NN
strategy0NN
continue0VB
death0NN
neonatal0JJ
malaria0NN
therapy0NN
management0NN
infection0NN
hiv0NN
positive0JJ
mother0NN
lack0.0383371018038178NN
access0.0157161992303584NN
rural0JJ
issue0NN
lead0.0383371018038178NN
cost0NN
clean0.125032076213024JJ
household0NN
setting0VBG

Horizontal community involvement is needed

Label: 13, with a score of: 0.598836439735411
WordScorePoS
community0.0343390275626203NN

Better environmental management especially in urban areas results

Label: 11, with a score of: 0.905141049704269
WordScorePoS
environmental0.0537696560159885JJ
management0.0687164195125178NN
urban0.27622591898666JJ
result0NN

Sources Annual proportions for main under five killer diseases Bryce and others Jefferson and others Luby and others Rabie and Curtis

Label: 3, with a score of: 0.775469069502536
WordScorePoS
source0NN
proportion0.025518364538905NN
killer0.0407408489778079NN
disease0.215415047323213NN

Label: 6, with a score of: 0.570951119938805
WordScorePoS
source0.0613562156822703NN
proportion0.0428007293971684NN
killer0NN
disease0.103230094596636NN

Note Neonatal causes include birth asphyxia low birth weight and neonatal tetanus

Label: 3, with a score of: 0.832833113397599
WordScorePoS
neonatal0.0407408489778079JJ
include0VB
birth0.0748292956291867NN

HOW ENVIRONMENTAL HEALTH SUPPLEMENTS OTHER CHILD SURVIVAL STRATEGIES â–  â–  infections either before the first pregnancy or between pregnancies

Label: 3, with a score of: 0.838994335978384
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
strategy0.0149758277542848NN
infection0.122222546933424NN

For conditions that are diagnosed during pregnancy or that must be treated or prevented during pregnancy for example anemia malaria hookworm or some combination of these conditions the safety of the treatment must be balanced with the adverse consequences of the disease Steketee

Label: 3, with a score of: 0.795086710029398
WordScorePoS
condition0NN
prevent0VB
malaria0.20370424488904NN
safety0NN
treatment0.0624189222007589NN
adverse0JJ
disease0.215415047323213NN

Currently reproductive health programs encourage public health approaches during pregnancy for anemia malaria and hookworm prevention and treatment because the substantial adverse consequences outweigh any risk associated with prevention and treatment Steketee

Label: 3, with a score of: 0.864854808200906
WordScorePoS
reproductive0.0923207345670913JJ
health0.191387734041787NN
encourage0VB
public0.021678073222951NN
approach0NN
malaria0.20370424488904NN
prevention0.0923207345670913NN
treatment0.0624189222007589NN
substantial0JJ
adverse0JJ
risk0.0703902516159815NN

Label: 5, with a score of: 0.259942904779345
WordScorePoS
reproductive0.13773238606089JJ
health0.0571058915334038NN
encourage0VB
public0.0727679293221751NN
approach0NN
malaria0NN
prevention0NN
treatment0NN
substantial0JJ
adverse0JJ
risk0NN

Label: 12, with a score of: 0.303844419748727
WordScorePoS
reproductive0JJ
health0.0339811641917276NN
encourage0.0468670845659596VB
public0.028867295332595NN
approach0.0542519672965169NN
malaria0NN
prevention0.0409791940864438NN
treatment0NN
substantial0.0332151194779746JJ
adverse0.0664302389559493JJ
risk0NN

Second there is growing drug resistance as well as widespread misuse of antibiotics to treat children for infections such as diarrhea Thapar and Sanderson

Label: 3, with a score of: 0.847291905428437
WordScorePoS
grow0VB
drug0.0407408489778079NN
child0.10682408961305NN
infection0.122222546933424NN

In older children the World Health Organization WHO is closely monitoring resistance to the drugs for helminth treatment while problems relating to reinfection remain Awasthi Bundy and Savioli Sur and others

Label: 3, with a score of: 0.766013505417166
WordScorePoS
child0.10682408961305NN
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
monitor0NN
drug0.0407408489778079NN
treatment0.0624189222007589NN
remain0VB

Label: 10, with a score of: 0.379019979215407
WordScorePoS
child0.0242343960710022NN
world0.00276879546803864NN
health0.0405241466500776NN
organization0.02794560829783NN
monitor0.0396106020715138NN
drug0NN
treatment0.0330412182586772NN
remain0.0396106020715138VB

Antimalarial drug resistance is weakening the effect of chemotherapy malaria control in Africa and constraining the drug options for the early treatment strategy recommended by WHO

Label: 3, with a score of: 0.939180804987996
WordScorePoS
drug0.0407408489778079NN
effect0NN
malaria0.20370424488904NN
control0.020806307400253NN
africa0IN
treatment0.0624189222007589NN
strategy0.0149758277542848NN
recommend0.0407408489778079VB

Third are problems related to compliance

Label: 6, with a score of: 0.792125750601621
WordScorePoS
related0.0524959536790166JJ

For example the uptake and use of oral rehydration therapy has possibly led to significant reductions in diarrhea mortality however use of oral rehydration therapy remains very low at around percent in countries such as Bangladesh and India Thapar and Sanderson

Label: 3, with a score of: 0.891045437120901
WordScorePoS
therapy0.0407408489778079NN
lead0.025518364538905NN
significant0.0127591822694525JJ
reduction0.0149758277542848NN
mortality0.276962203701274NN
remains0NNS
country0NN

Childbirth and Infant Care Programs The components of safe motherhood strategy usually fall primarily under the health promotion activities care packages organized and provided by health ministries Graham and others

Label: 3, with a score of: 0.818329219734014
WordScorePoS
childbirth0.0407408489778079NN
infant0NN
care0.104031537001265NN
safe0.0127591822694525JJ
strategy0.0149758277542848NN
fall0.123094312756122NN
primarily0RB
health0.191387734041787NN
promotion0NN
activity0NN
organize0VB

Label: 5, with a score of: 0.411647532130689
WordScorePoS
childbirth0NN
infant0NN
care0.0931221694711702NN
safe0JJ
strategy0NN
fall0NN
primarily0RB
health0.0571058915334038NN
promotion0.0931221694711702NN
activity0NN
organize0VB

They consist of for example community education evidence based prenatal care and counseling including primary prevention of peri or neonatal infections tetanus and HIV

Label: 3, with a score of: 0.848614511928289
WordScorePoS
community0NN
education0.0152605842304358NN
evidence0NN
base0.0149758277542848NN
care0.104031537001265NN
include0VB
primary0.0108390366114755JJ
prevention0.0923207345670913NN
perus0NN
neonatal0.0407408489778079JJ
infection0.122222546933424NN
hiv0.448149338755887NN

Label: 4, with a score of: 0.394328834043568
WordScorePoS
community0NN
education0.244244978014045NN
evidence0NN
base0NN
care0.0416255041156371NN
include0VB
primary0.108423939529757JJ
prevention0NN
perus0NN
neonatal0JJ
infection0NN
hiv0NN

Label: 10, with a score of: 0.161789468009662
WordScorePoS
community0.0202620733250388NN
education0.0121171980355011NN
evidence0.12939607756667NN
base0NN
care0NN
include0VB
primary0JJ
prevention0NN
perus0NN
neonatal0JJ
infection0NN
hiv0NN

In many developing countries unclean delivery practices traditional umbilical applications and the use of unclean cloths to swaddle the baby can have detrimental health effects on the newborn Bennett and others Mullany and others Quddus and others

Label: 3, with a score of: 0.680375329846538
WordScorePoS
develop0VB
country0NN
practice0NN
traditional0JJ
detrimental0JJ
health0.191387734041787NN
effect0NN
newborn0.0407408489778079JJ

Additionally in many developing countries the prevalence of multiresistant bacteria that cause neonatal infections major cause of neonatal deaths is rapidly increasing even while broad spectrum antibiotics are losing their effectiveness Bang and others Vergnano and others

Label: 3, with a score of: 0.932070150702456
WordScorePoS
additionally0RB
develop0VB
country0NN
prevalence0.0407408489778079NN
neonatal0.0407408489778079JJ
infection0.122222546933424NN
major0.0108390366114755JJ
death0.193573191943949NN
rapidly0RB
increase0.0143984997539974NN
lose0VB

Also difficulties remain in maintaining high coverage of tetanus immunizations for pregnant women to prevent neonatal sepsis

Label: 5, with a score of: 0.526312550090985
WordScorePoS
difficulty0NN
remain0VB
maintain0VB
coverage0NN
pregnant0JJ
woman0.221979360474357NN
prevent0VB
neonatal0JJ

Label: 2, with a score of: 0.547480003773896
WordScorePoS
difficulty0NN
remain0VB
maintain0.0881366997038154VB
coverage0NN
pregnant0.0583416713841148JJ
woman0.0546336178945768NN
prevent0.0297950283197006VB
neonatal0JJ

Label: 1, with a score of: 0.322199685549434
WordScorePoS
difficulty0NN
remain0VB
maintain0VB
coverage0.0908430554521382NN
pregnant0JJ
woman0.0450489732120807NN
prevent0VB
neonatal0JJ

In these areas hygienic and clean delivery practices supplemented by environmental health interventions approaches become even more important Mullany and others Quddus and others

Label: 3, with a score of: 0.621837686203821
WordScorePoS
clean0.020806307400253JJ
practice0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
approach0NN

Label: 7, with a score of: 0.307390003982882
WordScorePoS
clean0.125032076213024JJ
practice0NN
environmental0JJ
health0NN
intervention0NN
approach0NN

Label: 12, with a score of: 0.536837652671491
WordScorePoS
clean0JJ
practice0.0703006268489394NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
approach0.0542519672965169NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL By advocating hygienic practices for delivery and infant care several health sector programs in developing countries are already adopting environmental health principles related to clean household hygiene

Label: 3, with a score of: 0.664159826174026
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
practice0NN
infant0NN
care0.104031537001265NN
sector0NN
develop0VB
country0NN
adopt0VB
principle0NN
related0.0125195145191824JJ
clean0.020806307400253JJ
household0NN
hygiene0NN

Label: 6, with a score of: 0.219985303701495
WordScorePoS
environmental0JJ
health0NN
child0.0255958462813622NN
practice0NN
infant0NN
care0NN
sector0.0214003646985842NN
develop0VB
country0NN
adopt0VB
principle0NN
related0.0524959536790166JJ
clean0.0348974218717993JJ
household0NN
hygiene0.136665345449673NN

Label: 7, with a score of: 0.101474704987607
WordScorePoS
environmental0JJ
health0NN
child0NN
practice0NN
infant0NN
care0NN
sector0NN
develop0VB
country0NN
adopt0VB
principle0NN
related0JJ
clean0.125032076213024JJ
household0NN
hygiene0NN

Label: 5, with a score of: 0.367743763613184
WordScorePoS
environmental0JJ
health0.0571058915334038NN
child0.0170753354211044NN
practice0.0393804437159645NN
infant0NN
care0.0931221694711702NN
sector0.0571058915334038NN
develop0VB
country0NN
adopt0.0285529457667019VB
principle0NN
related0JJ
clean0JJ
household0.0465610847355851NN
hygiene0NN

Label: 12, with a score of: 0.316217880476541
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
practice0.0703006268489394NN
infant0NN
care0NN
sector0.0169905820958638NN
develop0VB
country0NN
adopt0.0169905820958638VB
principle0NN
related0.00833571598658786JJ
clean0JJ
household0.0554128417527413NN
hygiene0NN

Label: 10, with a score of: 0.302202914888334
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
child0.0242343960710022NN
practice0.02794560829783NN
infant0NN
care0NN
sector0NN
develop0VB
country0NN
adopt0.0202620733250388VB
principle0.0977392570420122NN
related0JJ
clean0JJ
household0.0330412182586772NN
hygiene0NN

Additional environmental health interventions such as providing clean water and sanitation play an augmentive yet important role in these health promotion efforts

Label: 6, with a score of: 0.76197277383403
WordScorePoS
additional0JJ
environmental0JJ
health0NN
intervention0NN
provide0VB
clean0.0348974218717993JJ
water0.556409482163189NN
sanitation0.334686906581616NN
promotion0NN
effort0NN

Label: 3, with a score of: 0.43638420268134
WordScorePoS
additional0JJ
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
provide0.0100171139310145VB
clean0.020806307400253JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
promotion0NN
effort0.0127591822694525NN

Label: 12, with a score of: 0.275410143742543
WordScorePoS
additional0JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
provide0.0200087191734851VB
clean0JJ
water0.186896403054502NN
sanitation0NN
promotion0NN
effort0NN

Label: 7, with a score of: 0.102885177889933
WordScorePoS
additional0JJ
environmental0JJ
health0NN
intervention0NN
provide0VB
clean0.125032076213024JJ
water0NN
sanitation0NN
promotion0NN
effort0NN

Only with adequate quantities of water and proper sanitation facilities can households with infants maintain clean surfaces practice proper hand washing and properly dispose of feces

Label: 6, with a score of: 0.861053219141184
WordScorePoS
adequate0.0295155485671997JJ
water0.556409482163189NN
proper0JJ
sanitation0.334686906581616NN
facility0NN
household0NN
infant0NN
maintain0VB
clean0.0348974218717993JJ
surface0NN
practice0NN

Label: 12, with a score of: 0.302824101681927
WordScorePoS
adequate0.0234335422829798JJ
water0.186896403054502NN
proper0JJ
sanitation0NN
facility0NN
household0.0554128417527413NN
infant0NN
maintain0VB
clean0JJ
surface0NN
practice0.0703006268489394NN

Label: 7, with a score of: 0.112672126844569
WordScorePoS
adequate0JJ
water0NN
proper0JJ
sanitation0NN
facility0NN
household0NN
infant0NN
maintain0VB
clean0.125032076213024JJ
surface0NN
practice0NN

Another important tenet of infant care programs is appropriate feeding practices

Label: 5, with a score of: 0.62962533553447
WordScorePoS
infant0NN
care0.0931221694711702NN
practice0.0393804437159645NN

Label: 3, with a score of: 0.494336600728625
WordScorePoS
infant0NN
care0.104031537001265NN
practice0NN

Label: 2, with a score of: 0.396973161617211
WordScorePoS
infant0.0583416713841148NN
care0NN
practice0.0252000451111224NN

Label: 12, with a score of: 0.334054209976477
WordScorePoS
infant0NN
care0NN
practice0.0703006268489394NN

Established evidence shows that exclusive breastfeeding can prevent malnutrition Adair and others Alvarado and others Chisti and others Cohen and others

Label: 10, with a score of: 0.652220212534045
WordScorePoS
establish0VB
evidence0.12939607756667NN
prevent0VB
malnutrition0NN

Consequently infant care programs through the health sector are encouraging breastfeeding practices as well as the postponement of the weaning period among severely malnourished infants to prevent death Pelletier

Label: 3, with a score of: 0.701666516727587
WordScorePoS
infant0NN
care0.104031537001265NN
health0.191387734041787NN
sector0NN
encourage0VB
practice0NN
period0NN
severely0RB
prevent0VB
death0.193573191943949NN

Label: 2, with a score of: 0.371958153552213
WordScorePoS
infant0.0583416713841148NN
care0NN
health0NN
sector0.0182713919265625NN
encourage0VB
practice0.0252000451111224NN
period0.0440683498519077NN
severely0RB
prevent0.0297950283197006VB
death0.0252000451111224NN

Label: 5, with a score of: 0.354016153927213
WordScorePoS
infant0NN
care0.0931221694711702NN
health0.0571058915334038NN
sector0.0571058915334038NN
encourage0VB
practice0.0393804437159645NN
period0NN
severely0RB
prevent0VB
death0NN

Label: 12, with a score of: 0.300069156663896
WordScorePoS
infant0NN
care0NN
health0.0339811641917276NN
sector0.0169905820958638NN
encourage0.0468670845659596VB
practice0.0703006268489394NN
period0.0409791940864438NN
severely0RB
prevent0VB
death0NN

Additionally as mentioned earlier inadequate sanitation compounds poor breastfeeding practices and synergistically affects child health

Label: 6, with a score of: 0.687512029039821
WordScorePoS
additionally0RB
inadequate0.0836717266454039JJ
sanitation0.334686906581616NN
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child0.0255958462813622NN
health0NN

Label: 3, with a score of: 0.427997471240491
WordScorePoS
additionally0RB
inadequate0JJ
sanitation0.0249430985430622NN
poor0JJ
practice0NN
affect0.00625975725959118VB
child0.10682408961305NN
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Label: 1, with a score of: 0.373953291335814
WordScorePoS
additionally0RB
inadequate0.0736315832425121JJ
sanitation0NN
poor0.150659516460257JJ
practice0NN
affect0.0184786920895884VB
child0.0450489732120807NN
health0NN

This need for improved sanitation to reduce diarrheal transmission to infants is seen even more starkly among countries with high rates of HIV prevalence

Label: 3, with a score of: 0.788746928338215
WordScorePoS
improve0VB
sanitation0.0249430985430622NN
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infant0NN
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rate0.0433561464459019NN
hiv0.448149338755887NN
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Label: 6, with a score of: 0.543170126659271
WordScorePoS
improve0.0511916925627245VB
sanitation0.334686906581616NN
reduce0.00936547854413134VB
infant0NN
country0NN
rate0NN
hiv0NN
prevalence0NN

Medical research has shown that for HIV positive mothers as many as

Label: 3, with a score of: 0.964812139881605
WordScorePoS
research0.0175975629039954NN
hiv0.448149338755887NN
positive0JJ
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percent of their infants can acquire HIV through breast milk over three year period Bertozzi and others

Label: 3, with a score of: 0.966929945209332
WordScorePoS
infant0NN
acquire0.0307735781890304NN
hiv0.448149338755887NN
period0NN

These mothers are faced with very difficult dilemma whether to breastfeed or not because their children may face severe malnourishment caused by diarrhea from bad water and poor sanitation or alternatively might acquire HIV if breastfed

Label: 6, with a score of: 0.748105040144104
WordScorePoS
mother0NN
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child0.0255958462813622NN
cause0NN
bad0.0683326727248364JJ
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hiv0NN

Label: 3, with a score of: 0.578912177219187
WordScorePoS
mother0.162963395911232NN
face0NN
child0.10682408961305NN
cause0NN
bad0JJ
water0.0382775468083574NN
poor0JJ
sanitation0.0249430985430622NN
acquire0.0307735781890304NN
hiv0.448149338755887NN

Label: 12, with a score of: 0.157487158172626
WordScorePoS
mother0NN
face0NN
child0NN
cause0NN
bad0JJ
water0.186896403054502NN
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sanitation0NN
acquire0NN
hiv0NN

Label: 1, with a score of: 0.139541440323788
WordScorePoS
mother0NN
face0NN
child0.0450489732120807NN
cause0NN
bad0JJ
water0NN
poor0.150659516460257JJ
sanitation0NN
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Exclusive breastfeeding even though uncommon might be safer than mixed breastfeeding for reducing HIV transmission risk Coovadia and others

Label: 3, with a score of: 0.973591992796222
WordScorePoS
reduce0.01675146888405VB
hiv0.448149338755887NN
risk0.0703902516159815NN

Even in these circumstances however healthy environments remain high priority

Label: 8, with a score of: 0.604263024839917
WordScorePoS
circumstance0.049270765107907NN
healthy0JJ
environment0.0591643007226199NN
remain0.049270765107907VB
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Label: 12, with a score of: 0.589924733281833
WordScorePoS
circumstance0.0332151194779746NN
healthy0JJ
environment0.079769385071606NN
remain0VB
priority0.0409791940864438NN

Label: 4, with a score of: 0.306000133819004
WordScorePoS
circumstance0NN
healthy0JJ
environment0.0299609328954485NN
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Immunization Programs The global Expanded Program on Immunization has been very effective in reducing mortality in children under five years of age Brenzel and others with sustainable reductions especially through measles whooping cough pertussis and tetanus vaccines Brenzel and others

Label: 3, with a score of: 0.842252649634625
WordScorePoS
global0.013959557403375JJ
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mortality0.276962203701274NN
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vaccine0.162963395911232NN

There is still potential to save an additional

Label: 9, with a score of: 0.547322558756465
WordScorePoS
potential0.0454743001434393NN
save0IN
additional0JJ

Label: 2, with a score of: 0.530400730193557
WordScorePoS
potential0NN
save0IN
additional0.0440683498519077JJ

Label: 15, with a score of: 0.470328418200371
WordScorePoS
potential0.0390772412228479NN
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Label: 17, with a score of: 0.444864317651522
WordScorePoS
potential0NN
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million children under the age of five annually by improving coverage with current licensed vaccines in South Asia and Sub Saharan Africa Brenzel and others however economic costs as well as logistical considerations for example the need to maintain cold chain for live vaccines constrain this possibility

Label: 3, with a score of: 0.639612767389296
WordScorePoS
child0.10682408961305NN
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annually0RB
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vaccine0.162963395911232NN
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africa0IN
economic0JJ
cost0NN
maintain0VB
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live0.0300513417930436VB

Label: 8, with a score of: 0.233628729538872
WordScorePoS
child0.0452169560888236NN
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annually0RB
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south0RB
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africa0IN
economic0.128463821595706JJ
cost0NN
maintain0VB
chain0NN
live0.00989353561471291VB

Label: 1, with a score of: 0.483236733781088
WordScorePoS
child0.0450489732120807NN
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annually0RB
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current0JJ
vaccine0NN
south0RB
asia0IN
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live0.0739258553811849VB

A very recent study from the WHO and United Nations Children Fund reporting percent drop in the number of measles deaths in Africa has attributed the decrease largely to better coverage in routine immunization programs and targeted campaigns Zaracostas

Label: 3, with a score of: 0.699463429813519
WordScorePoS
study0NN
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measles0.0407408489778079NNS
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HOW ENVIRONMENTAL HEALTH SUPPLEMENTS OTHER CHILD SURVIVAL STRATEGIES In recent years number of new vaccines against rotavirus pneumococcal infections hookworms and malaria have been developed and tested

Label: 3, with a score of: 0.943246798384947
WordScorePoS
environmental0JJ
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child0.10682408961305NN
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develop0VB

The rotavirus vaccine has shown promise but still faces several technical hurdles before it can be used widely against diarrheal disease in developing countries Banerjee and others Thapar and Sanderson

Label: 3, with a score of: 0.908528769515232
WordScorePoS
vaccine0.162963395911232NN
technical0JJ
widely0RB
disease0.215415047323213NN
develop0VB
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Also important rotavirus unlike other intestinal pathogens apparently is not strongly related to the lack of clean water sanitation and appropriate hygiene Thapar and Sanderson perhaps because low number of viruses is needed to infect an individual and because the virus tends to survive outside host long time that is it is difficult to wash away Eisenberg and others

Label: 6, with a score of: 0.931079292473923
WordScorePoS
related0.0524959536790166JJ
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Label: 12, with a score of: 0.173855273116505
WordScorePoS
related0.00833571598658786JJ
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sanitation0NN
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individual0JJ
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Label: 7, with a score of: 0.133833906131503
WordScorePoS
related0JJ
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clean0.125032076213024JJ
water0NN
sanitation0NN
hygiene0NN
individual0JJ
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time0NN

Some progress has also been achieved in hookworm vaccines Chu and others and several malaria vaccines are currently being tested in clinical trials where they have shown to provide some protection Komisar

Label: 3, with a score of: 0.920464362116546
WordScorePoS
progress0.0449274832628543NN
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Although progress continues with some setbacks Cutts and others Singleton and others in the field of new vaccines for example bacterial vaccines against neonatal sepsis and meningitis or pneumococcal infections and diarrhea for children under five the improvement of environmental health conditions especially water and sanitation should continue to be emphasized Thapar and Sanderson

Label: 6, with a score of: 0.632916844390501
WordScorePoS
progress0NN
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vaccine0NN
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child0.0255958462813622NN
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water0.556409482163189NN
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Label: 3, with a score of: 0.618112461195394
WordScorePoS
progress0.0449274832628543NN
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water0.0382775468083574NN
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Label: 12, with a score of: 0.249639716220105
WordScorePoS
progress0NN
continue0.0199423462679015VB
field0NN
vaccine0NN
neonatal0JJ
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environmental0.0598270388037045JJ
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sanitation0NN

Micronutrient Supplementation Programs Along with underweight micronutrient deficiencies such as in vitamin iron and zinc contribute to the global burden of disease in young children

Label: 3, with a score of: 0.756981795199122
WordScorePoS
contribute0VB
global0.013959557403375JJ
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disease0.215415047323213NN
child0.10682408961305NN

Label: 2, with a score of: 0.316328671299933
WordScorePoS
contribute0.0297950283197006VB
global0.0119942111830662JJ
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Like underweight micronutrient deficiencies increase susceptibility to infections which in turn may further aggravate the deficient state West

Label: 3, with a score of: 0.963292502894598
WordScorePoS
increase0.0143984997539974NN
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number of micronutrient supplementation programs are being undertaken in developing countries

Label: 5, with a score of: 0.85699270159895
WordScorePoS
undertake0.0688661930304451VB
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Several studies have shown that vitamin and zinc play key roles in determining the duration frequency and severity of infectious diseases such as diarrhea Guerrant Lima and Davidson

Label: 3, with a score of: 0.813725726714305
WordScorePoS
study0NN
key0NN
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However evidence also shows that the burden of infections in turn often constrains the effectiveness of these supplementation programs

Label: 10, with a score of: 0.691751221913753
WordScorePoS
evidence0.12939607756667NN
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infection0NN

Label: 3, with a score of: 0.65340153872164
WordScorePoS
evidence0NN
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Likely this effect is caused by malabsorption of key antimicrobial drugs resulting in the emergence of drug resistance in impoverished areas Guerrant Lima and Davidson

Label: 0, with a score of: 1

Research has revealed that infectious diseases such as diarrhea and respiratory infections and intestinal worm burdens may modify the growth response to vitamin supplementation Hadi and others West

Label: 3, with a score of: 0.742223493433588
WordScorePoS
research0.0175975629039954NN
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Label: 8, with a score of: 0.435774122041316
WordScorePoS
research0NN
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With heavy burden of respiratory infections supplemental vitamin may not be completely absorbed and can be expected to be excreted in high quantity Hadi Dibley and West

Label: 0, with a score of: 1

In research trial of Indonesian children those who experienced respiratory infections for more than days during four month observation period had percent reduction

Label: 1, with a score of: 0.611363726647799
WordScorePoS
research0NN
child0.0450489732120807NN
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day0.25973846344589NN
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Label: 3, with a score of: 0.560073959433127
WordScorePoS
research0.0175975629039954NN
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reduction0.0149758277542848NN

centimeters in four months in their linear growth response to vitamin supplementation compared with children ENVIRONMENTAL HEALTH AND CHILD SURVIVAL with no respiratory infection Hadi and others

Label: 3, with a score of: 0.711925791903914
WordScorePoS
growth0NN
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compare0.0307735781890304VB
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Label: 8, with a score of: 0.419197724651823
WordScorePoS
growth0.208565600657229NN
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child0.0452169560888236NN
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Results from trials of iron supplementation have not found significant growth effects even in anemic children Iannotti and others

Label: 8, with a score of: 0.605771904532157
WordScorePoS
result0NN
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child0.0452169560888236NN

Label: 10, with a score of: 0.421398399392095
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result0NN
significant0.0405241466500776JJ
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Label: 1, with a score of: 0.321433362630229
WordScorePoS
result0NN
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Iron supplementation in addition may actually lead to increased morbidity and consequently to reduced dietary intakes and poor nutrient absorption Iannotti and others

Label: 1, with a score of: 0.53288224407701
WordScorePoS
addition0NN
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Label: 12, with a score of: 0.437155360823375
WordScorePoS
addition0NN
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Also studies have found that the degree of infectious disease treatment is an important factor in determining who benefits and who is harmed in terms of serious infectious disease outcomes when low dose iron supplements are provided Iannotti and others

Label: 3, with a score of: 0.784684020981254
WordScorePoS
study0NN
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disease0.215415047323213NN
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Label: 13, with a score of: 0.246281210799077
WordScorePoS
study0NN
degree0.164469921319675NN
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Label: 17, with a score of: 0.224304224700963
WordScorePoS
study0NN
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Interventions to prevent or decrease malnutrition and infectious disease are expected to decrease child mortality and interventions that accomplish both will have the greatest effect Pelletier Pelletier and Frongillo

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WordScorePoS
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Environmental health interventions have an important complementary as well as supplementary role to play in addressing nutritional deficiencies

Label: 3, with a score of: 0.739407742896155
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.410922404125566
WordScorePoS
environmental0.0237821918091848JJ
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Water sanitation and hygiene have the potential to reduce zinc deficiencies that occur from losses during diarrheal illnesses

Label: 6, with a score of: 0.929896996555013
WordScorePoS
water0.556409482163189NN
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Label: 12, with a score of: 0.266337115690274
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water0.186896403054502NN
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Similarly efforts to reduce or control respiratory infections will help increase the effectiveness of vitamin supplementation programs in improving growth in children Hadi Dibley and West

Label: 8, with a score of: 0.503344125850152
WordScorePoS
effort0NN
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Label: 3, with a score of: 0.525306576080372
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Label: 10, with a score of: 0.325502926436868
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Label: 1, with a score of: 0.312756645338964
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Adapting Environmental Management Programs Recent evidence from verbal autopsy data provides concrete evidence that the mortality rates of children under five years of age caused by malaria in Sub Saharan Africa remain very high Adjuik and others

Label: 3, with a score of: 0.74572922534266
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.423039172512096
WordScorePoS
environmental0.0237821918091848JJ
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Label: 1, with a score of: 0.303477414567897
WordScorePoS
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Key strategies in the control of malaria have relied on early diagnosis and treatment on the use of insecticidetreated nets ITNs and to lesser extent on indoor residual spraying Mabaso Sharp and Lengeler WHO

Label: 3, with a score of: 0.806309178897967
WordScorePoS
key0NN
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The gains in malaria control in SubSaharan Africa achieved in the to from indoor residual spraying with DDT dichloro diphenyl trichloroethane and other insecticides were eroded in the mid with malarial epidemics becoming frequent and more severe Mabaso Sharp and Lengeler

Label: 3, with a score of: 0.858640331575221
WordScorePoS
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ITNs have been shown to reduce all cause mortality by about percent in community wide trials in several African settings WHO although recent observational community based intervention study suggests substantially higher efficacy of about percent Fegan and others

Label: 3, with a score of: 0.848830793064368
WordScorePoS
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Poor compliance with net retreatment combined with the additional cost of the insecticide and lack of understanding of its importance however pose difficult barriers to full implementation of ITNs in endemic countries Biran and others National Center for Infectious Diseases WHO

Label: 3, with a score of: 0.496098427601901
WordScorePoS
poor0JJ
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Label: 1, with a score of: 0.468454766297807
WordScorePoS
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In the case of communities with longerlasting nets the problem of retreatment is more or less obsolete but the problem of adherence to best practices with use of these nets remains an issue

Label: 0, with a score of: 1

With few options for malaria many rural households in Sub Saharan Africa continue to rely on smoke from indoor cooking as mosquito repellent Kristensen HOW ENVIRONMENTAL HEALTH SUPPLEMENTS OTHER CHILD SURVIVAL STRATEGIES

Label: 3, with a score of: 0.688349501119981
WordScorePoS
malaria0.20370424488904NN
rural0JJ
household0NN
saharan0.0299516555085695JJ
africa0IN
continue0VB
rely0VB
cooking0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
strategy0.0149758277542848NN

Label: 2, with a score of: 0.320796499995252
WordScorePoS
malaria0NN
rural0.148975141598503JJ
household0.0297950283197006NN
saharan0.0214456704626236JJ
africa0IN
continue0VB
rely0VB
cooking0NN
environmental0JJ
health0NN
child0.0546336178945768NN
strategy0NN

A recent review of research evidence investigated the association between indoor air pollution and malaria transmission Biran and others

Label: 3, with a score of: 0.711630986808457
WordScorePoS
review0NN
research0.0175975629039954NN
evidence0NN
air0.020806307400253NN
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malaria0.20370424488904NN

Label: 10, with a score of: 0.354563901115092
WordScorePoS
review0NN
research0NN
evidence0.12939607756667NN
air0NN
pollution0NN
malaria0NN

Label: 14, with a score of: 0.326301924649421
WordScorePoS
review0NN
research0.0229784274580034NN
evidence0NN
air0.0271683202880942NN
pollution0.0689352823740101NN
malaria0NN

The main findings were that smoke from domestic fuel use probably does not have much effect on mosquito feeding while the presence of eaves spaces makes houses more permeable to mosquitoes and has been associated with an increased risk of malaria Biran and others

Label: 3, with a score of: 0.712190915983995
WordScorePoS
domestic0JJ
fuel0NN
effect0NN
space0NN
increase0.0143984997539974NN
risk0.0703902516159815NN
malaria0.20370424488904NN

Soot from domestic fires may impair the effectiveness of ITNs because the nets are perceived to be dirty possibly resulting in an increase in the frequency of washing them and consequent loss of insecticide Biran and others

Label: 0, with a score of: 1

Conversely it can be concluded that reduction in indoor air pollution might have beneficial effects on malaria control by allowing ITNs to remain unwashed for longer periods

Label: 3, with a score of: 0.715973643790542
WordScorePoS
reduction0.0149758277542848NN
air0.020806307400253NN
pollution0.0175975629039954NN
effect0NN
malaria0.20370424488904NN
control0.020806307400253NN
remain0VB
period0NN

Strong evidence indicates that environmental management has been effective in controlling malaria although mosquito ecology in many tropical areas often makes this approach impractical Fewtrell and others Keiser Singer and Utzinger

Label: 3, with a score of: 0.634079929422623
WordScorePoS
strong0JJ
evidence0NN
environmental0JJ
management0.0127591822694525NN
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control0.020806307400253NN
malaria0.20370424488904NN
tropical0.0407408489778079JJ
approach0NN

Label: 10, with a score of: 0.4782187981216
WordScorePoS
strong0.0488696285210061JJ
evidence0.12939607756667NN
environmental0.0237821918091848JJ
management0NN
effective0.0145231653596925JJ
control0NN
malaria0NN
tropical0JJ
approach0NN

Malaria control methods that involve environmental management that is modification or manipulation of the environment to reduce malaria transmission for example through the installation cleaning and maintenance of drains or the systematic elimination of standing pools of water currently receive far less attention Keiser Singer and Utzinger

Label: 6, with a score of: 0.604332415571594
WordScorePoS
malaria0NN
control0NN
involve0VB
environmental0JJ
management0.0428007293971684NN
environment0NN
reduce0.00936547854413134VB
elimination0NN
water0.556409482163189NN
receive0VB
attention0.041835863322702NN

Label: 3, with a score of: 0.536572140662746
WordScorePoS
malaria0.20370424488904NN
control0.020806307400253NN
involve0VB
environmental0JJ
management0.0127591822694525NN
environment0NN
reduce0.01675146888405VB
elimination0NN
water0.0382775468083574NN
receive0.0814816979556159VB
attention0NN

Label: 12, with a score of: 0.431814259100533
WordScorePoS
malaria0NN
control0NN
involve0.0819583881728876VB
environmental0.0598270388037045JJ
management0.0339811641917276NN
environment0.079769385071606NN
reduce0.022306853314744VB
elimination0NN
water0.186896403054502NN
receive0VB
attention0NN

Adjusting Infrastructure Strategies Infrastructure investments such as in water supply sanitation and rural energy are typically designed with the primary objective of improving access or efficiency rather than maximizing public health effects although such interventions do sometimes recognize the importance of public health

Label: 6, with a score of: 0.534046981278552
WordScorePoS
infrastructure0.0181797964452808NN
strategy0NN
investment0NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
rural0JJ
energy0.0153390539205676NN
typically0RB
primary0JJ
objective0NN
improve0.0511916925627245VB
access0.00731085509381114NN
efficiency0.0502364757923669NN
public0NN
health0NN
effect0NN
intervention0NN
recognize0VB

Label: 7, with a score of: 0.46389416134813
WordScorePoS
infrastructure0.0651354046449052NN
strategy0NN
investment0.0383371018038178NN
water0NN
supply0.0528748274225028NN
sanitation0NN
rural0JJ
energy0.494617163780726NN
typically0RB
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objective0.0749457204978913NN
improve0.0229264916384433VB
access0.0157161992303584NN
efficiency0.134992154141495NN
public0NN
health0NN
effect0NN
intervention0NN
recognize0VB

Label: 9, with a score of: 0.426730719179217
WordScorePoS
infrastructure0.192202909044225NN
strategy0NN
investment0.0377086395700813NN
water0.0377086395700813NN
supply0NN
sanitation0.0737171311497939NN
rural0JJ
energy0.0540565419125769NN
typically0RB
primary0.0160169090870187JJ
objective0.0368585655748969NN
improve0VB
access0.0128821355880844NN
efficiency0.0442597400933733NN
public0.0160169090870187NN
health0.0377086395700813NN
effect0.0454743001434393NN
intervention0NN
recognize0.0368585655748969VB

Label: 12, with a score of: 0.296603962098775
WordScorePoS
infrastructure0.028867295332595NN
strategy0NN
investment0NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
rural0JJ
energy0.133960988253756NN
typically0RB
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objective0NN
improve0VB
access0.00232174891244877NN
efficiency0.039884692535803NN
public0.028867295332595NN
health0.0339811641917276NN
effect0NN
intervention0NN
recognize0VB

Label: 3, with a score of: 0.270258724264828
WordScorePoS
infrastructure0NN
strategy0.0149758277542848NN
investment0NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
rural0JJ
energy0NN
typically0RB
primary0.0108390366114755JJ
objective0NN
improve0VB
access0.00610236075888593NN
efficiency0NN
public0.021678073222951NN
health0.191387734041787NN
effect0NN
intervention0.0407408489778079NN
recognize0VB

Label: 2, with a score of: 0.14441748744136
WordScorePoS
infrastructure0.0155217067874935NN
strategy0NN
investment0.0182713919265625NN
water0NN
supply0NN
sanitation0NN
rural0.148975141598503JJ
energy0.0130963126055467NN
typically0RB
primary0.0155217067874935JJ
objective0NN
improve0.0218534471578307VB
access0.00749031153171887NN
efficiency0NN
public0NN
health0NN
effect0.0440683498519077NN
intervention0NN
recognize0VB

Yet with growing emphasis on increasing access to water supply systems and sanitation facilities and on moving poorer populations up the energy ladder there remains huge opportunity to appropriately incorporate public health considerations into the design and delivery of these interventions

Label: 6, with a score of: 0.687492418683597
WordScorePoS
grow0VB
increase0.00905621749519576NN
access0.00731085509381114NN
water0.556409482163189NN
supply0.0590310971343993NN
system0NN
sanitation0.334686906581616NN
facility0NN
move0NN
population0.0363595928905615NN
energy0.0153390539205676NN
remains0NNS
opportunity0.0153390539205676NN
public0NN
health0NN
intervention0NN

Label: 7, with a score of: 0.421987547543204
WordScorePoS
grow0VB
increase0.0162235147372888NN
access0.0157161992303584NN
water0NN
supply0.0528748274225028NN
system0NN
sanitation0NN
facility0NN
move0NN
population0NN
energy0.494617163780726NN
remains0NNS
opportunity0.0549574626423028NN
public0NN
health0NN
intervention0NN

Label: 12, with a score of: 0.369384439891224
WordScorePoS
grow0.0339811641917276VB
increase0.00958677785775002NN
access0.00232174891244877NN
water0.186896403054502NN
supply0.0703006268489394NN
system0NN
sanitation0NN
facility0NN
move0.0409791940864438NN
population0.0144336476662975NN
energy0.133960988253756NN
remains0NNS
opportunity0NN
public0.028867295332595NN
health0.0339811641917276NN
intervention0NN

Label: 3, with a score of: 0.224519409505711
WordScorePoS
grow0VB
increase0.0143984997539974NN
access0.00610236075888593NN
water0.0382775468083574NN
supply0NN
system0NN
sanitation0.0249430985430622NN
facility0NN
move0NN
population0NN
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remains0NNS
opportunity0NN
public0.021678073222951NN
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intervention0.0407408489778079NN

Improving Water Supply More than

Label: 6, with a score of: 0.912668507780688
WordScorePoS
improve0.0511916925627245VB
water0.556409482163189NN
supply0.0590310971343993NN

Label: 12, with a score of: 0.352121610963331
WordScorePoS
improve0VB
water0.186896403054502NN
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billion people still do not have access to safe drinking water

Label: 6, with a score of: 0.940276394471699
WordScorePoS
people0.024149913320522NNS
access0.00731085509381114NN
safe0.0428007293971684JJ
drinking0.206460189193271NN
water0.556409482163189NN

Label: 12, with a score of: 0.225992227761002
WordScorePoS
people0.0119834723221875NNS
access0.00232174891244877NN
safe0JJ
drinking0NN
water0.186896403054502NN

Service is poor even in many countries that have water supply systems

Label: 6, with a score of: 0.83059099817885
WordScorePoS
service0.0084006124696649NN
poor0.0642010940957526JJ
country0NN
water0.556409482163189NN
supply0.0590310971343993NN
system0NN

Label: 12, with a score of: 0.359555915832485
WordScorePoS
service0.00666957305782837NN
poor0.0339811641917276JJ
country0NN
water0.186896403054502NN
supply0.0703006268489394NN
system0NN

Label: 1, with a score of: 0.298128499232782
WordScorePoS
service0.0443555132287109NN
poor0.150659516460257JJ
country0NN
water0NN
supply0NN
system0.0519476926891779NN

For many consumers piped water is often intermittent and when available it is unsafe for drinking

Label: 6, with a score of: 0.824936838913823
WordScorePoS
consumer0NN
water0.556409482163189NN
drinking0.206460189193271NN

Label: 12, with a score of: 0.554097799729279
WordScorePoS
consumer0.325511803779102NN
water0.186896403054502NN
drinking0NN

With growing demands for water governments in developing countries are making some progress in extending coverage to improved water supply with large scale water supply projects especially in urban areas

Label: 6, with a score of: 0.874373984538731
WordScorePoS
grow0VB
demand0NN
water0.556409482163189NN
government0NN
develop0VB
country0NN
progress0NN
extend0VB
coverage0NN
improve0.0511916925627245VB
supply0.0590310971343993NN
scale0NN
project0.041835863322702NN
urban0JJ

Label: 12, with a score of: 0.372802463032949
WordScorePoS
grow0.0339811641917276VB
demand0NN
water0.186896403054502NN
government0NN
develop0VB
country0NN
progress0NN
extend0VB
coverage0NN
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supply0.0703006268489394NN
scale0NN
project0.0664302389559493NN
urban0JJ

Label: 11, with a score of: 0.215747941166242
WordScorePoS
grow0.0229054731708393VB
demand0NN
water0.0458109463416786NN
government0NN
develop0VB
country0NN
progress0NN
extend0VB
coverage0NN
improve0.0273960270556257VB
supply0NN
scale0NN
project0NN
urban0.27622591898666JJ

From health perspective water quantity is generally more important than water quality because increased quantities of water promote good hygiene and can prevent fecal oral transmission by number of different routes increased quantities of water also reduce skin and eye infections Boeston Kolsky and Hunt ENVIRONMENTAL HEALTH AND CHILD SURVIVAL

Label: 6, with a score of: 0.860735328751713
WordScorePoS
health0NN
perspective0NN
water0.556409482163189NN
quality0.0255958462813622NN
increase0.00905621749519576NN
promote0VB
hygiene0.136665345449673NN
prevent0VB
reduce0.00936547854413134VB
infection0NN
environmental0JJ
child0.0255958462813622NN

Label: 12, with a score of: 0.335711016890349
WordScorePoS
health0.0339811641917276NN
perspective0NN
water0.186896403054502NN
quality0.0203215381458133NN
increase0.00958677785775002NN
promote0.0148712355431627VB
hygiene0NN
prevent0VB
reduce0.022306853314744VB
infection0NN
environmental0.0598270388037045JJ
child0NN

Label: 3, with a score of: 0.294126183855745
WordScorePoS
health0.191387734041787NN
perspective0NN
water0.0382775468083574NN
quality0.0152605842304358NN
increase0.0143984997539974NN
promote0.00837573444202498VB
hygiene0NN
prevent0VB
reduce0.01675146888405VB
infection0.122222546933424NN
environmental0JJ
child0.10682408961305NN

Furthermore household water connections are considered optimal because consumption of water doubles or triples as households use it for improved hygiene practices Cairncross and Valdmanis and far greater health benefits result

Label: 6, with a score of: 0.788776680105596
WordScorePoS
household0NN
water0.556409482163189NN
consumption0NN
double0RB
triple0RB
improve0.0511916925627245VB
hygiene0.136665345449673NN
practice0NN
health0NN
benefit0NN
result0.0683326727248364NN

Label: 12, with a score of: 0.530678832233217
WordScorePoS
household0.0554128417527413NN
water0.186896403054502NN
consumption0.332151194779746NN
double0RB
triple0RB
improve0VB
hygiene0NN
practice0.0703006268489394NN
health0.0339811641917276NN
benefit0NN
result0NN

Label: 3, with a score of: 0.1543796309755
WordScorePoS
household0NN
water0.0382775468083574NN
consumption0NN
double0RB
triple0RB
improve0VB
hygiene0NN
practice0NN
health0.191387734041787NN
benefit0NN
result0NN

Label: 8, with a score of: 0.0938486274245146
WordScorePoS
household0NN
water0NN
consumption0.147812295323721NN
double0RB
triple0RB
improve0.0150723186962745VB
hygiene0NN
practice0NN
health0NN
benefit0NN
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In both urban and rural areas in developing countries people demand water supplies to reduce the time and cost of fetching water

Label: 6, with a score of: 0.816449458640379
WordScorePoS
urban0JJ
rural0JJ
develop0VB
country0NN
people0.024149913320522NNS
demand0NN
water0.556409482163189NN
supplies0NNS
reduce0.00936547854413134VB
time0NN
cost0NN

Label: 11, with a score of: 0.366470160611136
WordScorePoS
urban0.27622591898666JJ
rural0.0373517915079663JJ
develop0VB
country0NN
people0.0161552501392041NNS
demand0NN
water0.0458109463416786NN
supplies0.0731385760866977NNS
reduce0.0200483235258943VB
time0NN
cost0NN

Label: 12, with a score of: 0.322481912783362
WordScorePoS
urban0JJ
rural0JJ
develop0VB
country0NN
people0.0119834723221875NNS
demand0NN
water0.186896403054502NN
supplies0NNS
reduce0.022306853314744VB
time0.0169905820958638NN
cost0.0277064208763707NN

Label: 2, with a score of: 0.164389917113936
WordScorePoS
urban0JJ
rural0.148975141598503JJ
develop0VB
country0NN
people0.0257736572183839NNS
demand0.0297950283197006NN
water0NN
supplies0NNS
reduce0.00799614078871077VB
time0.0182713919265625NN
cost0NN

To meet demands for water governments have been increasing efforts to extend the coverage of piped water systems

Label: 6, with a score of: 0.892418101786955
WordScorePoS
meet0VB
demand0NN
water0.556409482163189NN
government0NN
increase0.00905621749519576NN
effort0NN
extend0VB
coverage0NN
system0NN

Label: 12, with a score of: 0.304966975053288
WordScorePoS
meet0VB
demand0NN
water0.186896403054502NN
government0NN
increase0.00958677785775002NN
effort0NN
extend0VB
coverage0NN
system0NN

The major investments in urban water focus on network solutions and thus reflect the needs of utilities which are concentrated on providing satisfactory service to their existing customers managing large amounts of water safely and efficiently meeting environmental standards for their wastewater discharges and recovering costs to permit continued operation maintenance replacement and expansion

Label: 6, with a score of: 0.778284983093822
WordScorePoS
major0JJ
investment0NN
urban0JJ
water0.556409482163189NN
focus0NN
solution0NN
reflect0VB
provide0VB
service0.0084006124696649NN
exist0VB
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amount0NN
environmental0JJ
standard0NN
wastewater0.204998018174509NN
discharge0.0683326727248364NN
cost0NN
continue0VB
expansion0NN

Label: 11, with a score of: 0.382071036488394
WordScorePoS
major0JJ
investment0NN
urban0.27622591898666JJ
water0.0458109463416786NN
focus0.0373517915079663NN
solution0NN
reflect0VB
provide0.0269743071558856VB
service0.0269743071558856NN
exist0.04477822029736VB
manage0VB
amount0NN
environmental0.0537696560159885JJ
standard0NN
wastewater0NN
discharge0NN
cost0NN
continue0.0537696560159885VB
expansion0.0731385760866977NN

Label: 12, with a score of: 0.347757460240517
WordScorePoS
major0JJ
investment0NN
urban0JJ
water0.186896403054502NN
focus0NN
solution0NN
reflect0.0409791940864438VB
provide0.0200087191734851VB
service0.00666957305782837NN
exist0.0332151194779746VB
manage0VB
amount0NN
environmental0.0598270388037045JJ
standard0.0409791940864438NN
wastewater0NN
discharge0NN
cost0.0277064208763707NN
continue0.0199423462679015VB
expansion0NN

Accordingly engineering financial and environmental perspectives dominate the design of network interventions and public health is reflected only in technical standards to reduce the risk of commonsource outbreaks from the water supply Boeston Kolsky and Hunt

Label: 6, with a score of: 0.602550549493723
WordScorePoS
engineering0NN
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perspective0NN
intervention0NN
public0NN
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reflect0VB
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standard0NN
reduce0.00936547854413134VB
risk0NN
water0.556409482163189NN
supply0.0590310971343993NN

Label: 12, with a score of: 0.46689284701015
WordScorePoS
engineering0NN
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environmental0.0598270388037045JJ
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public0.028867295332595NN
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technical0JJ
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reduce0.022306853314744VB
risk0NN
water0.186896403054502NN
supply0.0703006268489394NN

Label: 3, with a score of: 0.371754732335175
WordScorePoS
engineering0NN
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environmental0JJ
perspective0NN
intervention0.0407408489778079NN
public0.021678073222951NN
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reflect0VB
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reduce0.01675146888405VB
risk0.0703902516159815NN
water0.0382775468083574NN
supply0NN

Label: 11, with a score of: 0.301544124609484
WordScorePoS
engineering0NN
financial0.0112376090361851JJ
environmental0.0537696560159885JJ
perspective0NN
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public0.0583751976558017NN
health0.0229054731708393NN
reflect0VB
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reduce0.0200483235258943VB
risk0.0631828116343571NN
water0.0458109463416786NN
supply0NN

In rural areas the time saving benefits of water access are even more pronounced and the most obvious benefit is that water is made available closer to where rural households need it Cairncross and Valdmanis

Label: 6, with a score of: 0.839290831985279
WordScorePoS
rural0JJ
time0NN
save0IN
benefit0NN
water0.556409482163189NN
access0.00731085509381114NN
household0NN

Label: 12, with a score of: 0.336065535547532
WordScorePoS
rural0JJ
time0.0169905820958638NN
save0IN
benefit0NN
water0.186896403054502NN
access0.00232174891244877NN
household0.0554128417527413NN

Label: 2, with a score of: 0.302639501679569
WordScorePoS
rural0.148975141598503JJ
time0.0182713919265625NN
save0IN
benefit0.0252000451111224NN
water0NN
access0.00749031153171887NN
household0.0297950283197006NN

Accordingly government investments in rural water supply aim at improving access however the smaller size of rural communities means that piped systems in general and house connections in particular tend to be more expensive per capita Cairncross and Valdmanis

Label: 6, with a score of: 0.665578183157831
WordScorePoS
government0NN
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rural0JJ
water0.556409482163189NN
supply0.0590310971343993NN
aim0NN
improve0.0511916925627245VB
access0.00731085509381114NN
size0NN
community0.0214003646985842NN
means0NNS
system0NN
expensive0JJ
capita0NN

Label: 2, with a score of: 0.420626147615512
WordScorePoS
government0NN
investment0.0182713919265625NN
rural0.148975141598503JJ
water0NN
supply0NN
aim0NN
improve0.0218534471578307VB
access0.00749031153171887NN
size0NN
community0.0182713919265625NN
means0NNS
system0.0756001353333673NN
expensive0JJ
capita0NN

Label: 12, with a score of: 0.374916246662964
WordScorePoS
government0NN
investment0NN
rural0JJ
water0.186896403054502NN
supply0.0703006268489394NN
aim0.0277064208763707NN
improve0VB
access0.00232174891244877NN
size0NN
community0.0169905820958638NN
means0NNS
system0NN
expensive0.0542519672965169JJ
capita0.0332151194779746NN

Microbial contamination of drinking water in rural and urban areas can occur either at the source through seepage of contaminated runoff water or within the piped distribution system

Label: 6, with a score of: 0.899670636568395
WordScorePoS
contamination0NN
drinking0.206460189193271NN
water0.556409482163189NN
rural0JJ
urban0JJ
occur0VB
source0.0613562156822703NN
contaminate0.0683326727248364VB
system0NN

Label: 11, with a score of: 0.271205460534162
WordScorePoS
contamination0NN
drinking0NN
water0.0458109463416786NN
rural0.0373517915079663JJ
urban0.27622591898666JJ
occur0VB
source0NN
contaminate0VB
system0.0315914058171786NN

Label: 12, with a score of: 0.257533761027869
WordScorePoS
contamination0NN
drinking0NN
water0.186896403054502NN
rural0JJ
urban0JJ
occur0.0409791940864438VB
source0NN
contaminate0VB
system0NN

Label: 2, with a score of: 0.147571336334662
WordScorePoS
contamination0NN
drinking0NN
water0NN
rural0.148975141598503JJ
urban0JJ
occur0VB
source0.0130963126055467NN
contaminate0VB
system0.0756001353333673NN

Moreover unhygienic handling of water during transport or within the home can contaminate previously safe water WHO

Label: 6, with a score of: 0.924378266870649
WordScorePoS
water0.556409482163189NN
transport0NN
contaminate0.0683326727248364VB
safe0.0428007293971684JJ

Label: 12, with a score of: 0.303228434181305
WordScorePoS
water0.186896403054502NN
transport0.0277064208763707NN
contaminate0VB
safe0JJ

Household water treatment technologies such as chlorination and solar disinfection and safe storage can be important interventions in situations where access to water supplies is secure but household water quality is not assured WHO

Label: 6, with a score of: 0.883220080755462
WordScorePoS
household0NN
water0.556409482163189NN
treatment0.0348974218717993NN
technology0.0153390539205676NN
safe0.0428007293971684JJ
intervention0NN
situation0.0295155485671997NN
access0.00731085509381114NN
supplies0NNS
secure0JJ
quality0.0255958462813622NN

Label: 12, with a score of: 0.335999621091887
WordScorePoS
household0.0554128417527413NN
water0.186896403054502NN
treatment0NN
technology0NN
safe0JJ
intervention0NN
situation0NN
access0.00232174891244877NN
supplies0NNS
secure0JJ
quality0.0203215381458133NN

Improving Sanitation Roughly

Label: 6, with a score of: 0.969069652617994
WordScorePoS
improve0.0511916925627245VB
sanitation0.334686906581616NN

billion people in the developing world are without adequate sanitation and facilities are often overloaded in disrepair or unused

Label: 6, with a score of: 0.892444409058907
WordScorePoS
people0.024149913320522NNS
develop0VB
world0.00438651305628668NN
adequate0.0295155485671997JJ
sanitation0.334686906581616NN
facility0NN

Even though the sanitation gap is twice as large as that of water supply investments in sanitation and hygiene have lagged far behind those in water and other social sectors such as health and education

Label: 6, with a score of: 0.908815463519459
WordScorePoS
sanitation0.334686906581616NN
gap0NN
water0.556409482163189NN
supply0.0590310971343993NN
investment0NN
hygiene0.136665345449673NN
social0JJ
sector0.0214003646985842NN
health0NN
education0NN

Label: 12, with a score of: 0.237383549517195
WordScorePoS
sanitation0NN
gap0NN
water0.186896403054502NN
supply0.0703006268489394NN
investment0NN
hygiene0NN
social0.0169905820958638JJ
sector0.0169905820958638NN
health0.0339811641917276NN
education0.0101607690729067NN

Label: 3, with a score of: 0.151412276480532
WordScorePoS
sanitation0.0249430985430622NN
gap0NN
water0.0382775468083574NN
supply0NN
investment0NN
hygiene0NN
social0JJ
sector0NN
health0.191387734041787NN
education0.0152605842304358NN

Label: 4, with a score of: 0.127029819437944
WordScorePoS
sanitation0NN
gap0NN
water0NN
supply0.0352060273355634NN
investment0NN
hygiene0NN
social0JJ
sector0NN
health0NN
education0.244244978014045NN

The main costs of urban sanitation services are those of sewers and sewage treatment

Label: 6, with a score of: 0.65099616978468
WordScorePoS
cost0NN
urban0JJ
sanitation0.334686906581616NN
service0.0084006124696649NN
sewage0NN
treatment0.0348974218717993NN

Label: 11, with a score of: 0.648161056877788
WordScorePoS
cost0NN
urban0.27622591898666JJ
sanitation0NN
service0.0269743071558856NN
sewage0.0731385760866977NN
treatment0NN

Whereas sewers contribute to public health through reducing everyday contact with sewage especially by children wastewater treatment is designed largely to meet ecological objectives and not those of public health Boeston HOW ENVIRONMENTAL HEALTH SUPPLEMENTS OTHER CHILD SURVIVAL STRATEGIES Kolsky and Hunt

Label: 3, with a score of: 0.726457923800209
WordScorePoS
contribute0VB
public0.021678073222951NN
health0.191387734041787NN
reduce0.01675146888405VB
sewage0NN
child0.10682408961305NN
wastewater0NN
treatment0.0624189222007589NN
meet0.0307735781890304VB
objective0NN
environmental0JJ
strategy0.0149758277542848NN

Label: 6, with a score of: 0.228291050860358
WordScorePoS
contribute0VB
public0NN
health0NN
reduce0.00936547854413134VB
sewage0NN
child0.0255958462813622NN
wastewater0.204998018174509NN
treatment0.0348974218717993NN
meet0VB
objective0NN
environmental0JJ
strategy0NN

Urban utilities by and large are not well designed or staffed to address off network solutions for water supply or sanitation yet those solutions are likely to be the most important first steps of progress in environmental health for many of the urban poor

Label: 6, with a score of: 0.725805451530415
WordScorePoS
urban0JJ
solution0NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
progress0NN
environmental0JJ
health0NN
poor0.0642010940957526JJ

Label: 11, with a score of: 0.499343648952466
WordScorePoS
urban0.27622591898666JJ
solution0NN
water0.0458109463416786NN
supply0NN
sanitation0NN
progress0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
poor0.0229054731708393JJ

Label: 12, with a score of: 0.275478016975831
WordScorePoS
urban0JJ
solution0NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
progress0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
poor0.0339811641917276JJ

Label: 3, with a score of: 0.214333664984578
WordScorePoS
urban0JJ
solution0NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
progress0.0449274832628543NN
environmental0JJ
health0.191387734041787NN
poor0JJ

Label: 1, with a score of: 0.139438227719927
WordScorePoS
urban0JJ
solution0NN
water0NN
supply0NN
sanitation0NN
progress0NN
environmental0.0442083771593746JJ
health0NN
poor0.150659516460257JJ

Rural sanitation is frequently low priority relative to food shelter schooling and employment

Label: 2, with a score of: 0.656367310780461
WordScorePoS
rural0.148975141598503JJ
sanitation0NN
priority0NN
relative0JJ
food0.292342270824999NN
shelter0NN
schooling0NN
employment0.0252000451111224NN

Label: 6, with a score of: 0.500997424380395
WordScorePoS
rural0JJ
sanitation0.334686906581616NN
priority0NN
relative0JJ
food0.0214003646985842NN
shelter0NN
schooling0NN
employment0NN

Label: 12, with a score of: 0.320609851726274
WordScorePoS
rural0JJ
sanitation0NN
priority0.0409791940864438NN
relative0JJ
food0.186896403054502NN
shelter0NN
schooling0NN
employment0NN

Label: 8, with a score of: 0.24453469034889
WordScorePoS
rural0JJ
sanitation0NN
priority0NN
relative0JJ
food0NN
shelter0NN
schooling0NN
employment0.173804667214358NN

Families that invest in rural sanitation usually do so for other reasons for cleanliness dignity modernity comfort and convenience more than for public health

Label: 6, with a score of: 0.615952103777757
WordScorePoS
family0.0348974218717993NN
invest0VB
rural0JJ
sanitation0.334686906581616NN
public0NN
health0NN

Label: 3, with a score of: 0.500695344604091
WordScorePoS
family0.0624189222007589NN
invest0VB
rural0JJ
sanitation0.0249430985430622NN
public0.021678073222951NN
health0.191387734041787NN

Label: 2, with a score of: 0.395172430854816
WordScorePoS
family0.0297950283197006NN
invest0.0583416713841148VB
rural0.148975141598503JJ
sanitation0NN
public0NN
health0NN

For variety of historical political and institutional reasons public health plays little role in project design despite large role in project justification of both water supply and sanitation investments in developing countries Kolsky and others

Label: 6, with a score of: 0.817396360491213
WordScorePoS
variety0NN
historical0JJ
political0JJ
institutional0JJ
public0NN
health0NN
project0.041835863322702NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
investment0NN
develop0VB
country0NN

Label: 12, with a score of: 0.358100185087324
WordScorePoS
variety0NN
historical0JJ
political0JJ
institutional0JJ
public0.028867295332595NN
health0.0339811641917276NN
project0.0664302389559493NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
investment0NN
develop0VB
country0NN

Label: 3, with a score of: 0.218452034094676
WordScorePoS
variety0NN
historical0JJ
political0JJ
institutional0JJ
public0.021678073222951NN
health0.191387734041787NN
project0NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
investment0NN
develop0VB
country0NN

The roles for the infrastructure sector have largely been related to improving access for example increasing the number of tap connections while those of the health sector have traditionally focused on improved treatment strategies

Label: 9, with a score of: 0.557208878248744
WordScorePoS
infrastructure0.192202909044225NN
sector0.0565629593551219NN
related0.00925008066007716JJ
improve0VB
access0.0128821355880844NN
increase0.0159575617614215NN
health0.0377086395700813NN
focus0.030745604615229NN
treatment0NN
strategy0NN

Label: 3, with a score of: 0.408298902324906
WordScorePoS
infrastructure0NN
sector0NN
related0.0125195145191824JJ
improve0VB
access0.00610236075888593NN
increase0.0143984997539974NN
health0.191387734041787NN
focus0NN
treatment0.0624189222007589NN
strategy0.0149758277542848NN

Label: 6, with a score of: 0.36138353015895
WordScorePoS
infrastructure0.0181797964452808NN
sector0.0214003646985842NN
related0.0524959536790166JJ
improve0.0511916925627245VB
access0.00731085509381114NN
increase0.00905621749519576NN
health0NN
focus0NN
treatment0.0348974218717993NN
strategy0NN

Opportunities remain for the health sector to take on larger role in improving the health outcomes of infrastructure investments through promotion for example hygiene promotion or support to the marketing of sanitation and advocacy for example persuading utilities to lower their off putting connection charges and to recover the connection costs through the monthly tariff so that house connections are more affordable to the poor

Label: 6, with a score of: 0.526202131995368
WordScorePoS
opportunity0.0153390539205676NN
remain0VB
health0NN
sector0.0214003646985842NN
improve0.0511916925627245VB
outcome0NN
infrastructure0.0181797964452808NN
investment0NN
promotion0NN
hygiene0.136665345449673NN
support0.0209983814716066NN
sanitation0.334686906581616NN
put0VBN
cost0NN
affordable0.0214003646985842JJ
poor0.0642010940957526JJ

Label: 9, with a score of: 0.433985901055619
WordScorePoS
opportunity0.0135141354781442NN
remain0VB
health0.0377086395700813NN
sector0.0565629593551219NN
improve0VB
outcome0.030745604615229NN
infrastructure0.192202909044225NN
investment0.0377086395700813NN
promotion0NN
hygiene0NN
support0.0277502419802315NN
sanitation0.0737171311497939NN
put0VBN
cost0NN
affordable0.0565629593551219JJ
poor0JJ

Label: 3, with a score of: 0.338074262867267
WordScorePoS
opportunity0NN
remain0VB
health0.191387734041787NN
sector0NN
improve0VB
outcome0NN
infrastructure0NN
investment0NN
promotion0NN
hygiene0NN
support0.00625975725959118NN
sanitation0.0249430985430622NN
put0VBN
cost0NN
affordable0.025518364538905JJ
poor0JJ

Label: 1, with a score of: 0.15907924510539
WordScorePoS
opportunity0NN
remain0VB
health0NN
sector0NN
improve0VB
outcome0NN
infrastructure0NN
investment0.0376648791150643NN
promotion0NN
hygiene0NN
support0.0184786920895884NN
sanitation0NN
put0VBN
cost0NN
affordable0JJ
poor0.150659516460257JJ

Relatively easy improvements in public health outcomes can be achieved in number of ways â–  Relatively low cost hygiene promotion programs that attempt behavior change in household hygiene through wide range of social marketing tools can be implemented

Label: 13, with a score of: 0.527855622227501
WordScorePoS
improvement0NN
public0NN
health0NN
outcome0NN
achieve0VB
cost0.0279982034978914NN
hygiene0NN
promotion0NN
change0.402565546215053NN
household0NN
wide0.0414107553022249JJ
range0.0335649154577099NN
social0JJ
tool0NN
implement0.0102677744436108VB

Label: 6, with a score of: 0.312675835497296
WordScorePoS
improvement0NN
public0NN
health0NN
outcome0NN
achieve0.0194103228106253VB
cost0NN
hygiene0.136665345449673NN
promotion0NN
change0NN
household0NN
wide0JJ
range0NN
social0JJ
tool0NN
implement0.0127979231406811VB

Label: 3, with a score of: 0.279008481735284
WordScorePoS
improvement0NN
public0.021678073222951NN
health0.191387734041787NN
outcome0NN
achieve0.00385756426954823VB
cost0NN
hygiene0NN
promotion0NN
change0NN
household0NN
wide0.0307735781890304JJ
range0.0249430985430622NN
social0JJ
tool0NN
implement0VB

Label: 5, with a score of: 0.379224777302203
WordScorePoS
improvement0NN
public0.0727679293221751NN
health0.0571058915334038NN
outcome0.0465610847355851NN
achieve0.0258977780207001VB
cost0NN
hygiene0NN
promotion0.0931221694711702NN
change0NN
household0.0465610847355851NN
wide0JJ
range0NN
social0.0285529457667019JJ
tool0NN
implement0VB

Label: 10, with a score of: 0.32922183970237
WordScorePoS
improvement0NN
public0.0172128079963482NN
health0.0405241466500776NN
outcome0.0330412182586772NN
achieve0.018377882320743VB
cost0.0660824365173543NN
hygiene0NN
promotion0NN
change0NN
household0.0330412182586772NN
wide0JJ
range0NN
social0.101310366625194JJ
tool0NN
implement0.0121171980355011VB

Neither network utilities nor rural water engineering staff members are naturally inclined to assign high priority to hygiene promotion although it is highly cost effective as health intervention Laxminarayan Chow and Shahid Salles

Label: 6, with a score of: 0.77510290229226
WordScorePoS
rural0JJ
water0.556409482163189NN
engineering0NN
priority0NN
hygiene0.136665345449673NN
promotion0NN
highly0RB
cost0NN
effective0JJ
health0NN
intervention0NN

Label: 12, with a score of: 0.323834099847847
WordScorePoS
rural0JJ
water0.186896403054502NN
engineering0NN
priority0.0409791940864438NN
hygiene0NN
promotion0NN
highly0RB
cost0.0277064208763707NN
effective0JJ
health0.0339811641917276NN
intervention0NN

Label: 3, with a score of: 0.312637471822201
WordScorePoS
rural0JJ
water0.0382775468083574NN
engineering0NN
priority0NN
hygiene0NN
promotion0NN
highly0RB
cost0NN
effective0.00914534810831654JJ
health0.191387734041787NN
intervention0.0407408489778079NN

Label: 2, with a score of: 0.166606923267021
WordScorePoS
rural0.148975141598503JJ
water0NN
engineering0NN
priority0NN
hygiene0NN
promotion0NN
highly0RB
cost0NN
effective0JJ
health0NN
intervention0NN

â–  Urban water and sewerage network expansions can often be sequenced in different ways and relatively easy way to speed public health improvement is to stress the need to extend services to new areas as quickly as possible

Label: 6, with a score of: 0.615234835300364
WordScorePoS
urban0JJ
water0.556409482163189NN
expansion0NN
public0NN
health0NN
improvement0NN
stress0NN
extend0VB
service0.0084006124696649NN
quickly0RB

Label: 11, with a score of: 0.548375346167612
WordScorePoS
urban0.27622591898666JJ
water0.0458109463416786NN
expansion0.0731385760866977NN
public0.0583751976558017NN
health0.0229054731708393NN
improvement0NN
stress0NN
extend0VB
service0.0269743071558856NN
quickly0RB

Label: 12, with a score of: 0.338401871811778
WordScorePoS
urban0JJ
water0.186896403054502NN
expansion0NN
public0.028867295332595NN
health0.0339811641917276NN
improvement0NN
stress0.0542519672965169NN
extend0VB
service0.00666957305782837NN
quickly0RB

Label: 3, with a score of: 0.284694034356909
WordScorePoS
urban0JJ
water0.0382775468083574NN
expansion0NN
public0.021678073222951NN
health0.191387734041787NN
improvement0NN
stress0NN
extend0VB
service0.0100171139310145NN
quickly0RB

â–  Trade offs between ideal environmental objectives and the priorities of public health can be explored

Label: 3, with a score of: 0.546421342355953
WordScorePoS
trade0.0149758277542848NN
environmental0JJ
objective0NN
priority0NN
public0.021678073222951NN
health0.191387734041787NN

Label: 12, with a score of: 0.392140745283229
WordScorePoS
trade0NN
environmental0.0598270388037045JJ
objective0NN
priority0.0409791940864438NN
public0.028867295332595NN
health0.0339811641917276NN

Label: 11, with a score of: 0.323600472662827
WordScorePoS
trade0NN
environmental0.0537696560159885JJ
objective0NN
priority0NN
public0.0583751976558017NN
health0.0229054731708393NN

Label: 5, with a score of: 0.311196801947513
WordScorePoS
trade0NN
environmental0JJ
objective0NN
priority0NN
public0.0727679293221751NN
health0.0571058915334038NN

Wastewater treatment systems are by and large designed to achieve ecological objectives not public health ones

Label: 3, with a score of: 0.565482192136497
WordScorePoS
wastewater0NN
treatment0.0624189222007589NN
system0NN
achieve0.00385756426954823VB
objective0NN
public0.021678073222951NN
health0.191387734041787NN

Label: 6, with a score of: 0.524921555033288
WordScorePoS
wastewater0.204998018174509NN
treatment0.0348974218717993NN
system0NN
achieve0.0194103228106253VB
objective0NN
public0NN
health0NN

Label: 5, with a score of: 0.315333793631388
WordScorePoS
wastewater0NN
treatment0NN
system0NN
achieve0.0258977780207001VB
objective0NN
public0.0727679293221751NN
health0.0571058915334038NN

If strict environmental standards are adopted in poor countries the often high costs of such systems means that wastewater treatment comes at the expense of depriving the poor of basic access to sanitation

Label: 6, with a score of: 0.690281215502119
WordScorePoS
environmental0JJ
standard0NN
adopt0VB
poor0.0642010940957526JJ
country0NN
cost0NN
system0NN
means0NNS
wastewater0.204998018174509NN
treatment0.0348974218717993NN
basic0.0181797964452808JJ
access0.00731085509381114NN
sanitation0.334686906581616NN

Label: 1, with a score of: 0.556111313347723
WordScorePoS
environmental0.0442083771593746JJ
standard0NN
adopt0VB
poor0.150659516460257JJ
country0NN
cost0NN
system0.0519476926891779NN
means0.120266261535276NNS
wastewater0NN
treatment0NN
basic0.0639932865717261JJ
access0.00514687440545096NN
sanitation0NN

The costs and benefits of wastewater treatment need to be balanced against the public health benefits and costs of basic access

Label: 3, with a score of: 0.46237657739771
WordScorePoS
cost0NN
benefit0NN
wastewater0NN
treatment0.0624189222007589NN
public0.021678073222951NN
health0.191387734041787NN
basic0JJ
access0.00610236075888593NN

Label: 6, with a score of: 0.435773929189838
WordScorePoS
cost0NN
benefit0NN
wastewater0.204998018174509NN
treatment0.0348974218717993NN
public0NN
health0NN
basic0.0181797964452808JJ
access0.00731085509381114NN

Label: 10, with a score of: 0.368354087325635
WordScorePoS
cost0.0660824365173543NN
benefit0NN
wastewater0NN
treatment0.0330412182586772NN
public0.0172128079963482NN
health0.0405241466500776NN
basic0JJ
access0.00138439773401932NN

Label: 5, with a score of: 0.355399621515173
WordScorePoS
cost0NN
benefit0.0393804437159645NN
wastewater0NN
treatment0NN
public0.0727679293221751NN
health0.0571058915334038NN
basic0JJ
access0.00780347258345989NN

Moving up the Energy Ladder Worldwide more than billion people continue to rely on solid fuels including biomass and coal to meet their most basic energy needs cooking boiling water and heating WHO

Label: 7, with a score of: 0.839645324470235
WordScorePoS
move0NN
energy0.494617163780726NN
worldwide0RB
people0.0108156764915259NNS
continue0VB
rely0.0749457204978913VB
fuel0.0749457204978913NN
include0VB
coal0.122412709674631NN
meet0VB
basic0JJ
cooking0.122412709674631NN
water0NN
heating0.122412709674631NN

Label: 6, with a score of: 0.348335359850659
WordScorePoS
move0NN
energy0.0153390539205676NN
worldwide0RB
people0.024149913320522NNS
continue0VB
rely0VB
fuel0NN
include0VB
coal0NN
meet0VB
basic0.0181797964452808JJ
cooking0NN
water0.556409482163189NN
heating0NN

Label: 12, with a score of: 0.336807502526433
WordScorePoS
move0.0409791940864438NN
energy0.133960988253756NN
worldwide0RB
people0.0119834723221875NNS
continue0.0199423462679015VB
rely0.0332151194779746VB
fuel0.0332151194779746NN
include0VB
coal0NN
meet0VB
basic0.0144336476662975JJ
cooking0NN
water0.186896403054502NN
heating0NN

To address this issue developing countries have made ENVIRONMENTAL HEALTH AND CHILD SURVIVAL various rural energy investments to move these people up the energy ladder toward cleaner fuels

Label: 7, with a score of: 0.833209658212545
WordScorePoS
issue0NN
develop0VB
country0NN
environmental0JJ
health0NN
child0NN
rural0JJ
energy0.494617163780726NN
investment0.0383371018038178NN
move0NN
people0.0108156764915259NNS
cleaner0.0924643738905717JJR
fuel0.0749457204978913NN

Label: 12, with a score of: 0.309505812981648
WordScorePoS
issue0NN
develop0VB
country0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
rural0JJ
energy0.133960988253756NN
investment0NN
move0.0409791940864438NN
people0.0119834723221875NNS
cleaner0JJR
fuel0.0332151194779746NN

Label: 3, with a score of: 0.227032095957415
WordScorePoS
issue0.0249430985430622NN
develop0VB
country0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
rural0JJ
energy0NN
investment0NN
move0NN
people0.00539943740774902NNS
cleaner0JJR
fuel0NN

Label: 2, with a score of: 0.189228747175511
WordScorePoS
issue0NN
develop0VB
country0NN
environmental0JJ
health0NN
child0.0546336178945768NN
rural0.148975141598503JJ
energy0.0130963126055467NN
investment0.0182713919265625NN
move0NN
people0.0257736572183839NNS
cleaner0JJR
fuel0NN

Nevertheless progress since has been negligible because the small gains made are lagging population growth WHO

Label: 8, with a score of: 0.759227380759028
WordScorePoS
progress0.0591643007226199NN
gain0NN
population0.0428212738652355NN
growth0.208565600657229NN

Label: 10, with a score of: 0.483689876559153
WordScorePoS
progress0NN
gain0NN
population0.0860640399817412NN
growth0.11178243319132NN

Recent decades have witnessed many household energy initiatives ranging from ambitious government run improved cookstove programs to small scale community led projects

Label: 7, with a score of: 0.789064998243786
WordScorePoS
decade0NN
household0NN
energy0.494617163780726NN
initiative0.0924643738905717NN
range0NN
government0NN
improve0.0229264916384433VB
scale0NN
community0NN
lead0.0383371018038178NN
project0NN

Label: 12, with a score of: 0.352681578863933
WordScorePoS
decade0NN
household0.0554128417527413NN
energy0.133960988253756NN
initiative0NN
range0NN
government0NN
improve0VB
scale0NN
community0.0169905820958638NN
lead0.0169905820958638NN
project0.0664302389559493NN

Label: 13, with a score of: 0.30216228444673
WordScorePoS
decade0.124232265906675NN
household0NN
energy0.0123065238088614NN
initiative0NN
range0.0335649154577099NN
government0NN
improve0.0102677744436108VB
scale0NN
community0.0343390275626203NN
lead0NN
project0.0335649154577099NN

Cleaner fuels and improved cookstove programs that reduce indoor air pollution can mitigate diseases such as respiratory and other illnesses World Bank

Label: 3, with a score of: 0.600945313931078
WordScorePoS
cleaner0JJR
fuel0NN
improve0VB
reduce0.01675146888405VB
air0.020806307400253NN
pollution0.0175975629039954NN
disease0.215415047323213NN
illness0.0407408489778079NN
world0.00087176582269799NN
bank0NN

Label: 6, with a score of: 0.437364318034834
WordScorePoS
cleaner0JJR
fuel0NN
improve0.0511916925627245VB
reduce0.00936547854413134VB
air0NN
pollution0.0590310971343993NN
disease0.103230094596636NN
illness0NN
world0.00438651305628668NN
bank0NN

Label: 7, with a score of: 0.387584092054804
WordScorePoS
cleaner0.0924643738905717JJR
fuel0.0749457204978913NN
improve0.0229264916384433VB
reduce0.00838876601975825VB
air0NN
pollution0NN
disease0NN
illness0NN
world0.00261936653839306NN
bank0NN

Studies in India and Nepal have revealed that women who were exposed to biomass smoke but who did not smoke themselves had chronic respiratory disease death rates comparable to those of heavy male smokers Modi and others World Bank

Label: 3, with a score of: 0.75305783267145
WordScorePoS
study0NN
woman0.0381514605760894NN
chronic0JJ
disease0.215415047323213NN
death0.193573191943949NN
rate0.0433561464459019NN
world0.00087176582269799NN
bank0NN

Label: 5, with a score of: 0.349169626733187
WordScorePoS
study0NN
woman0.221979360474357NN
chronic0JJ
disease0NN
death0NN
rate0NN
world0.00585260443759492NN
bank0NN

Label: 6, with a score of: 0.334504088155291
WordScorePoS
study0NN
woman0.0127979231406811NN
chronic0.0683326727248364JJ
disease0.103230094596636NN
death0.0295155485671997NN
rate0NN
world0.00438651305628668NN
bank0NN

Improved cookstove programs have an enormous potential to affect respiratory health

Label: 3, with a score of: 0.701364593463029
WordScorePoS
improve0VB
potential0NN
affect0.00625975725959118VB
health0.191387734041787NN

Label: 9, with a score of: 0.328004404862568
WordScorePoS
improve0VB
potential0.0454743001434393NN
affect0.00925008066007716VB
health0.0377086395700813NN

They can especially benefit women and young children who are disproportionately affected by respiratory disease

Label: 3, with a score of: 0.642241200375142
WordScorePoS
benefit0NN
woman0.0381514605760894NN
child0.10682408961305NN
affect0.00625975725959118VB
disease0.215415047323213NN

Label: 5, with a score of: 0.487719474325587
WordScorePoS
benefit0.0393804437159645NN
woman0.221979360474357NN
child0.0170753354211044NN
affect0VB
disease0NN

In the past however such programs have more often focused on energy efficiency criteria rather than on health considerations

Label: 7, with a score of: 0.847553750150296
WordScorePoS
focus0NN
energy0.494617163780726NN
efficiency0.134992154141495NN
criterion0NN
health0NN

Label: 12, with a score of: 0.279767812882899
WordScorePoS
focus0NN
energy0.133960988253756NN
efficiency0.039884692535803NN
criterion0NN
health0.0339811641917276NN

Label: 3, with a score of: 0.257638168785684
WordScorePoS
focus0NN
energy0NN
efficiency0NN
criterion0NN
health0.191387734041787NN

The first improved cookstove programs in India for example were more concerned with the potential to burn biomass energy more cleanly and efficiently than with health outcomes

Label: 7, with a score of: 0.813610570224489
WordScorePoS
improve0.0229264916384433VB
potential0NN
energy0.494617163780726NN
health0NN
outcome0NN

Label: 3, with a score of: 0.300873330775535
WordScorePoS
improve0VB
potential0NN
energy0NN
health0.191387734041787NN
outcome0NN

Label: 12, with a score of: 0.264015429394513
WordScorePoS
improve0VB
potential0NN
energy0.133960988253756NN
health0.0339811641917276NN
outcome0NN

Secondary benefits generally included conserving fuel reducing smoke emission in the cooking area keeping kitchens clean reducing deforestation Agarwal World Bank lessening the drudgery of women reducing cooking time and improving employment opportunities for the rural poor

Label: 7, with a score of: 0.506665422477745
WordScorePoS
secondary0JJ
benefit0NN
include0VB
conserve0VB
fuel0.0749457204978913NN
reduce0.00838876601975825VB
emission0.0625160381065121NN
cooking0.122412709674631NN
clean0.125032076213024JJ
deforestation0NN
world0.00261936653839306NN
bank0NN
lessen0VB
woman0NN
time0NN
improve0.0229264916384433VB
employment0NN
opportunity0.0549574626423028NN
rural0JJ
poor0JJ

Label: 2, with a score of: 0.413067487281072
WordScorePoS
secondary0JJ
benefit0.0252000451111224NN
include0VB
conserve0VB
fuel0NN
reduce0.00799614078871077VB
emission0NN
cooking0NN
clean0JJ
deforestation0NN
world0.0124838525528648NN
bank0.0881366997038154NN
lessen0VB
woman0.0546336178945768NN
time0.0182713919265625NN
improve0.0218534471578307VB
employment0.0252000451111224NN
opportunity0.0261926252110933NN
rural0.148975141598503JJ
poor0.0548141757796873JJ

Label: 5, with a score of: 0.373388089310032
WordScorePoS
secondary0.0688661930304451JJ
benefit0.0393804437159645NN
include0VB
conserve0VB
fuel0.0558185411034276NN
reduce0VB
emission0NN
cooking0NN
clean0JJ
deforestation0NN
world0.00585260443759492NN
bank0NN
lessen0VB
woman0.221979360474357NN
time0NN
improve0VB
employment0.0393804437159645NN
opportunity0.02046578088155NN
rural0JJ
poor0JJ

Label: 8, with a score of: 0.238451881389332
WordScorePoS
secondary0JJ
benefit0NN
include0VB
conserve0VB
fuel0NN
reduce0.0055149369084567VB
emission0NN
cooking0NN
clean0JJ
deforestation0NN
world0.00172202218602071NN
bank0NN
lessen0VB
woman0.0452169560888236NN
time0NN
improve0.0150723186962745VB
employment0.173804667214358NN
opportunity0.0361300980868102NN
rural0JJ
poor0JJ

Label: 1, with a score of: 0.204762641315493
WordScorePoS
secondary0JJ
benefit0NN
include0VB
conserve0VB
fuel0NN
reduce0.0164833460638534VB
emission0NN
cooking0NN
clean0JJ
deforestation0NN
world0.00257343720272548NN
bank0NN
lessen0VB
woman0.0450489732120807NN
time0NN
improve0VB
employment0NN
opportunity0NN
rural0JJ
poor0.150659516460257JJ

Label: 13, with a score of: 0.191191691347573
WordScorePoS
secondary0JJ
benefit0NN
include0VB
conserve0VB
fuel0NN
reduce0.00375696197697663VB
emission0.19598742448524NN
cooking0NN
clean0JJ
deforestation0NN
world0.00351929966767313NN
bank0NN
lessen0VB
woman0.0102677744436108NN
time0NN
improve0.0102677744436108VB
employment0NN
opportunity0NN
rural0JJ
poor0JJ

The most organized intervention of rural household stoves China National Improved Stove Program NISP focused primarily on fuel efficiency

Label: 7, with a score of: 0.504835263078036
WordScorePoS
organize0VB
intervention0NN
rural0JJ
household0NN
national0JJ
improve0.0229264916384433VB
focus0NN
primarily0RB
fuel0.0749457204978913NN
efficiency0.134992154141495NN

Label: 2, with a score of: 0.443606916235258
WordScorePoS
organize0VB
intervention0NN
rural0.148975141598503JJ
household0.0297950283197006NN
national0.00399807039435538JJ
improve0.0218534471578307VB
focus0NN
primarily0RB
fuel0NN
efficiency0NN

Label: 11, with a score of: 0.348780616028442
WordScorePoS
organize0VB
intervention0NN
rural0.0373517915079663JJ
household0NN
national0.00501208088147356JJ
improve0.0273960270556257VB
focus0.0373517915079663NN
primarily0RB
fuel0NN
efficiency0.0537696560159885NN

However major independent review of NISP including household survey in three provinces at different levels of coverage found that the program improved air quality and health in rural households but not sufficiently to meet Chinese indoor air quality standards Zhang and Smith

Label: 2, with a score of: 0.431108708637077
WordScorePoS
major0JJ
review0NN
include0VB
household0.0297950283197006NN
survey0NN
level0.00552410547653725NN
coverage0NN
improve0.0218534471578307VB
air0NN
quality0.0109267235789154NN
health0NN
rural0.148975141598503JJ
meet0.0881366997038154VB
standard0NN

Label: 3, with a score of: 0.418615113376437
WordScorePoS
major0.0108390366114755JJ
review0NN
include0VB
household0NN
survey0NN
level0NN
coverage0.0307735781890304NN
improve0VB
air0.020806307400253NN
quality0.0152605842304358NN
health0.191387734041787NN
rural0JJ
meet0.0307735781890304VB
standard0NN

Whereas the supply of technology is more concerned with energy efficiency and costs the demand for cookstoves has reflected limited awareness of the health effect of improved cookstoves

Label: 7, with a score of: 0.759723317953459
WordScorePoS
supply0.0528748274225028NN
technology0.109914925284606NN
energy0.494617163780726NN
efficiency0.134992154141495NN
cost0NN
demand0NN
reflect0VB
limited0JJ
awareness0NN
health0NN
effect0NN
improve0.0229264916384433VB

Label: 12, with a score of: 0.399530816498465
WordScorePoS
supply0.0703006268489394NN
technology0NN
energy0.133960988253756NN
efficiency0.039884692535803NN
cost0.0277064208763707NN
demand0NN
reflect0.0409791940864438VB
limited0JJ
awareness0.0819583881728876NN
health0.0339811641917276NN
effect0NN
improve0VB

Label: 3, with a score of: 0.197723177924054
WordScorePoS
supply0NN
technology0NN
energy0NN
efficiency0NN
cost0NN
demand0.020806307400253NN
reflect0VB
limited0JJ
awareness0NN
health0.191387734041787NN
effect0NN
improve0VB

In India for example perceived benefits cited by users of improved cookstoves included reduction in time spent in cooking reduced fuel consumption health benefits such as reduction of eye irritation and cleaner kitchens

Label: 12, with a score of: 0.595885696909455
WordScorePoS
benefit0NN
user0NN
improve0VB
include0VB
reduction0.0199423462679015NN
time0.0169905820958638NN
cooking0NN
reduce0.022306853314744VB
fuel0.0332151194779746NN
consumption0.332151194779746NN
health0.0339811641917276NN
cleaner0JJR

Label: 3, with a score of: 0.312369285675775
WordScorePoS
benefit0NN
user0NN
improve0VB
include0VB
reduction0.0149758277542848NN
time0.0127591822694525NN
cooking0NN
reduce0.01675146888405VB
fuel0NN
consumption0NN
health0.191387734041787NN
cleaner0JJR

Label: 8, with a score of: 0.209698381088732
WordScorePoS
benefit0NN
user0NN
improve0.0150723186962745VB
include0VB
reduction0NN
time0NN
cooking0NN
reduce0.0055149369084567VB
fuel0NN
consumption0.147812295323721NN
health0NN
cleaner0JJR

Label: 7, with a score of: 0.399894959800343
WordScorePoS
benefit0NN
user0NN
improve0.0229264916384433VB
include0VB
reduction0NN
time0NN
cooking0.122412709674631NN
reduce0.00838876601975825VB
fuel0.0749457204978913NN
consumption0NN
health0NN
cleaner0.0924643738905717JJR

Yet only percent of the households cited health benefits as perceived benefit

Label: 3, with a score of: 0.576459304547341
WordScorePoS
household0NN
health0.191387734041787NN
benefit0NN

Label: 5, with a score of: 0.549472200847141
WordScorePoS
household0.0465610847355851NN
health0.0571058915334038NN
benefit0.0393804437159645NN

This finding suggests that users over the years had accepted the burning sensation in the eyes and coughing as daily facts of life and considered only medical issues that required visit to the rural doctor as health issues World Bank

Label: 3, with a score of: 0.542878599715245
WordScorePoS
suggest0VB
user0NN
daily0RB
life0.0250390290383647NN
issue0.0249430985430622NN
require0VB
rural0JJ
health0.191387734041787NN
world0.00087176582269799NN
bank0NN

Label: 2, with a score of: 0.50714036992013
WordScorePoS
suggest0VB
user0NN
daily0RB
life0NN
issue0NN
require0VB
rural0.148975141598503JJ
health0NN
world0.0124838525528648NN
bank0.0881366997038154NN

In Guatemala similarly respondents from three improved cookstove programs were found to value the benefits from lower fuelwood use reduced cooking times and less smoke

Label: 7, with a score of: 0.617645238399665
WordScorePoS
improve0.0229264916384433VB
benefit0NN
reduce0.00838876601975825VB
cooking0.122412709674631NN
time0NN

Significantly the advantages of reduced eye irritation and better respiratory health were perceived to be the lowest benefits under the program Ahmed and others

Label: 3, with a score of: 0.767963533550194
WordScorePoS
significantly0RB
reduce0.01675146888405VB
health0.191387734041787NN
benefit0NN

This evidence of HOW ENVIRONMENTAL HEALTH SUPPLEMENTS OTHER CHILD SURVIVAL STRATEGIES households undervaluing the health benefits associated with improved cookstoves highlights opportunities for raising awareness through variety of public media or social marketing approaches

Label: 3, with a score of: 0.482344239771379
WordScorePoS
evidence0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
strategy0.0149758277542848NN
household0NN
benefit0NN
improve0VB
opportunity0NN
raise0NN
awareness0NN
variety0NN
public0.021678073222951NN
media0NNS
social0JJ
approach0NN

Label: 10, with a score of: 0.413542854520383
WordScorePoS
evidence0.12939607756667NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
child0.0242343960710022NN
strategy0NN
household0.0330412182586772NN
benefit0NN
improve0.0121171980355011VB
opportunity0.029046330719385NN
raise0NN
awareness0NN
variety0NN
public0.0172128079963482NN
media0NNS
social0.101310366625194JJ
approach0NN

Label: 12, with a score of: 0.414962287572892
WordScorePoS
evidence0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
strategy0NN
household0.0554128417527413NN
benefit0NN
improve0VB
opportunity0NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
variety0NN
public0.028867295332595NN
media0.0542519672965169NNS
social0.0169905820958638JJ
approach0.0542519672965169NN

Label: 1, with a score of: 0.336127911189473
WordScorePoS
evidence0NN
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
strategy0.0442083771593746NN
household0NN
benefit0NN
improve0VB
opportunity0NN
raise0NN
awareness0NN
variety0.120266261535276NN
public0NN
media0NNS
social0.112994637345193JJ
approach0NN

Label: 5, with a score of: 0.310728748396265
WordScorePoS
evidence0NN
environmental0JJ
health0.0571058915334038NN
child0.0170753354211044NN
strategy0NN
household0.0465610847355851NN
benefit0.0393804437159645NN
improve0VB
opportunity0.02046578088155NN
raise0NN
awareness0NN
variety0NN
public0.0727679293221751NN
media0NNS
social0.0285529457667019JJ
approach0NN

From health perspective behavior change components are also important supplements in clean stove programs

Label: 13, with a score of: 0.795713866761845
WordScorePoS
health0NN
perspective0.0548233071065585NN
change0.402565546215053NN
clean0JJ

Label: 7, with a score of: 0.401488191643914
WordScorePoS
health0NN
perspective0NN
change0.105749654845006NN
clean0.125032076213024JJ

Label: 3, with a score of: 0.369151412399956
WordScorePoS
health0.191387734041787NN
perspective0NN
change0NN
clean0.020806307400253JJ

In Bangladesh for example pollution exposure for children in typical household can be halved by adopting two simple measures increasing children outdoor time from three to five or six hours day and concentrating outdoor time during peak cooking periods Dasgupta and others

Label: 1, with a score of: 0.636352035230836
WordScorePoS
pollution0NN
exposure0.120266261535276NN
child0.0450489732120807NN
household0NN
halve0VB
adopt0VB
simple0JJ
measure0.103895385378356NN
increase0NN
time0NN
day0.25973846344589NN
cooking0NN
period0NN

Including such health promotion activities in rural energy projects is important in raising awareness of health benefits associated with improved indoor air and creating demand for improvement of cookstoves and changes in behavior

Label: 7, with a score of: 0.55824955121275
WordScorePoS
include0VB
health0NN
promotion0NN
activity0NN
rural0JJ
energy0.494617163780726NN
project0NN
raise0NN
awareness0NN
benefit0NN
improve0.0229264916384433VB
air0NN
create0VB
demand0NN
improvement0.0924643738905717NN

Label: 12, with a score of: 0.441391854457176
WordScorePoS
include0VB
health0.0339811641917276NN
promotion0NN
activity0.0199423462679015NN
rural0JJ
energy0.133960988253756NN
project0.0664302389559493NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
benefit0NN
improve0VB
air0.0554128417527413NN
create0.0234335422829798VB
demand0NN
improvement0NN

Label: 3, with a score of: 0.388379243266944
WordScorePoS
include0VB
health0.191387734041787NN
promotion0NN
activity0NN
rural0JJ
energy0NN
project0NN
raise0NN
awareness0NN
benefit0NN
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Key Messages â–  â–  Current child survival strategies in developing countries focus on case management and treatment to the neglect of primary prevention especially relating to reducing exposure to infections

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These strategies typically intend to increase the ability of the host to resist or reduce infection after exposure has occurred but they do not attempt to reduce the exposure to environmental determinants of ill health

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Environmental health actions incorporated into existing child health strategies can provide bigger bang for the buck in terms of health improvements and they are an important complement and supplement to other existing strategies addressing child health by adding value to health systems adapting environmental management programs and adjusting infrastructure strategies

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Label: 9, with a score of: 0.270180206029043
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environmental0.0221298700466866JJ
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infrastructure0.192202909044225NN

Label: 17, with a score of: 0.259851760429515
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environmental0JJ
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Notes Conversely neglect of environmental health action through vector habitat control has been responsible for the resurgence of dengue virus in almost all continents Cattand and others Kay and Nam and forceful comeback of African trypanosomiasis spread by tsetse flies in Central and East Africa in the past few decades Remme and others

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Improved water supply is defined to encompass reasonable access to protected water resources which include rainwater collection protected springs and dug wells boreholes public standpipes and household connections

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In addition it involves the application of measures to protect the water source from contamination Hutton and Haller

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Reasonable access means at least liters per person per day accessible within kilometer of that person dwelling WHO and UNICEF

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Label: 11, with a score of: 0.549256953351882
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Improved sanitation involves access to sanitation facilities that allow for safe disposal of excreta which may include connection to sewer or septic tank system pour flush latrine simple pit or ventilated improved pit latrine WHO and UNICEF

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I Economics H E How Large Is the Environmental Health Burden

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Label: 12, with a score of: 0.346323308362511
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THE PREVIOUS CHAPTERS REVISITED THE RESEARCH evidence on malnutrition infection links to demonstrate the importance of environmental health interventions for child survival and development and pointed toward the complementary role of environmental health interventions in other child survival strategies

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Given this evidence quantitatively measuring the importance of environmental health issues for better child health becomes important

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Label: 10, with a score of: 0.375139905590419
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Furthermore to make decisions regarding investments in environmental health actions policymakers need to get sense of the averted health costs

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Hence this chapter seeks to answer the following questions â–  How large is the environmental health burden for children under five after considering its links through malnutrition

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â–  Which subregions have the highest environmental health burdens

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Label: 12, with a score of: 0.357899080308486
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â–  What are the economic costs associated with these burdens at country level

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Answering these questions will help policy makers appreciate the magnitude of the environmental health burden and better integrate environmental health into decision making for economic development

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Furthermore translating health effects into economic costs such as percentage of country gross domestic product has been powerful means of raising awareness about environmental health issues and facilitating progress toward sustainable development

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL This chapter looks at the methodology used by the World Health Organization WHO to estimate the burden of disease within and across various subregions of the world specifically in the context of environmental health risks

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environmental0JJ
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This methodology dynamic and evolving over the past decade has been applied to assess and compare the health status of populations in countries and subregions

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Label: 10, with a score of: 0.480310884526076
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Results from the latest WHO analysis of environmental health burdens incorporate the complex links between malnutrition and infections into the calculations and provide basis for comparisons across different subregions

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The next chapter extends this analysis to estimate the corresponding burden at the country level and the consequent economic costs to society

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Burden of Disease In the field of health challenge one faces when trying to choose between different health sector interventions is deciding how to compare different health outcomes or end points

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For example how does one compare environmental interventions that differ in terms of how many lives of children are saved mortality and how many days of various illnesses morbidity are avoided

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How would one choose between an intervention that saved child lives and cases of illness for example and another that saved lives and cases of illness

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Also how would one compare case of diarrheal illness averted to case of respiratory infection averted

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The Global Burden of Disease Project initiated by WHO in aims at answering these questions and in doing so provides useful guidance for policy making WHO

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To assist governments in setting priority actions in health WHO developed methodology to evaluate the burden of disease and to quantify the health status of population

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One of the most commonly used summary measures of population health is the disability adjusted life year DALY which creates common metric to measure both the potential years of life lost to premature death and the years of healthy life lost because of disability or illness

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One DALY can be thought of as one lost year of healthy life

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Environmental Burden of Disease paper assessing the global environmental burden of disease reported that about percent of the total burden of disease attributable to environmental risks falls on children under five years of age even though they make up only percent of the population Smith Corvalán and Kjellström

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Since then important reports on environmental health burden estimation were undertaken in the framework of the Global Burden of Disease Project

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In section of the World Health Report WHO chapter quantified the significance of environmental health risks which were revisited in depth in by the Comparative HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

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Risk Assessment project Ezzati and others Ezzati Lopez and others Ezzati Rodgers and others Ezzati Vander Hoorn and others

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The method used to calculate the environmental burden of disease is based on an exposure approach supported by comprehensive analysis of evidence on specific health risks

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Exposure response relationships for given risk factor such as poor water sanitation and hygiene WSH are obtained from epidemiological studies and the derived attributable fractions are then applied to disease burden in deaths or DALYs associated with the same risk factor see WHO n

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WHO Comparative Risk Assessment considers the following six environmental risk factors and examines them in relation to the diseases identified in table

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Ezzati Lopez and others

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The risk factor approach quantified WSH and indoor air pollution as having the greatest effect on children under five years of age Ezzati Vander Hoorn and others Ezzati Rodgers and others

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This risk factor approach to assessing health status is particularly useful to Policy makers because it enables them to think of specific interventions to address specific environmental risks

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In WHO published Prüss Üstün and Corvalán environmental health report Preventing Disease through Healthy Environments

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Using different approach from earlier studies the report elicited expert opinions on the fractions of different diseases attributable to environmental factors

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Apart from water sanitation and indoor air pollution malaria emerged as an important environmental health problem among children under five especially in Sub Saharan Africa

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The report estimated that among children up to years of age the proportion of deaths attributable to the environment was as high as percent Prüss Üstün and Corvalán which compares to an attributable disease burden of percent TABLE

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Environmental Risk Factors and Related Diseases Included in the Comparative Risk Assessment Risk Factor Related Diseases Water sanitation hygiene Diarrheal diseases trachoma schistosomiasis ascariasis trichuriasis hookworm disease Chronic obstructive pulmonary disease lower respiratory infections lung cancer Respiratory infections selected cardiopulmonary diseases lung cancer Mild mental retardation cardiovascular diseases Diarrheal diseases malaria unintentional injuries protein energy malnutrition Unintentional injuries hearing loss cancers asthma chronic obstructive pulmonary disease lower back pain Indoor air pollution Outdoor air pollution Lead Climate change Selected occupational risk factors Source WHO

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL for all age groups

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A number of earlier studies had led the way toward these important findings

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In the same report expert opinion indicated that poor WSH contributed to percent of the consequences of childhood and maternal underweight see box

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For example when environmentally attributable deaths from acute lower respiratory infection ALRI were reported they were caused by indoor air pollution

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Nevertheless perhaps up to percent of these deaths would not have occurred if the child had not been malnourished Ezzati Vander Hoorn and others

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The implications of this link were mainly reported through the consequences of different environmental risks as deaths in different disease categories

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Current literature on risk factors has internalized significant portion of these consequences of malnutrition often without much discussion

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Although the WHO report Prüss Üstün and Corvalán did include relatively small category measles and meningitis deaths of child deaths associated with BOX

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Why Percent

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Supporting Evidence from Recent Cohort Studies In Preventing Disease through Healthy Environments Prüss Üstün and Corvalán expert opinion was cited as indicating that poor water sanitation and hygiene and inadequate water resources management contributed to percent of the consequences of childhood and maternal underweight

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This expert opinion builds on evidence that emerged toward the end of the on the impacts of environmental infections on child growth Keusch Scrimshaw Taylor and Gordon

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In this report technical review of recent cohort studies further corroborates this percent confidence interval to percent figure used to estimate the consequences of malnutrition attributable to environmental risk factors

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Evidence from several of the studies demonstrates how exposure to environmental health risks in early infancy leads to permanent growth faltering lowered immunity and increased mortality

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Using Bradford Hill causality criteria as framework the results from the studies were scrutinized to evaluate whether infections cause growth faltering and if so to what extent for details see appendix

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For example recent relatively large study from Bangladesh reveals that dysentery and watery diarrhea together could retard weight gain by to percent compared with those periods where no infections occurred Alam and others

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This weight gain retardation is likely to be significantly higher when compared with international standards and simulations that reveal percent weight gain retardation result in approximately similar environmentally attributable health burden as the estimate in PrüssÜstün and Corvalán

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international0JJ
standard0NN
result0NN
approximately0RB
environmentally0RB
health0.191387734041787NN
burden0NN
estimate0.059903311017139NN

HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

Label: 3, with a score of: 0.730186612776455
WordScorePoS
environmental0JJ
health0.191387734041787NN
burden0NN

Label: 12, with a score of: 0.357899080308486
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN

malnutrition it did not include other deaths that would have been avoided had the child not been malnourished

Label: 3, with a score of: 0.766616226217918
WordScorePoS
malnutrition0NN
include0VB
death0.193573191943949NN
avoid0VB
child0.10682408961305NN

Label: 1, with a score of: 0.302873713913416
WordScorePoS
malnutrition0.0736315832425121NN
include0VB
death0NN
avoid0VB
child0.0450489732120807NN

Including the Malnutrition Infection Link As discussed in chapter there is now substantial evidence that repeated infections in early childhood mainly diarrheal disease from inadequate WSH is significant contributor to child malnutrition Prüss Üstün and Corvalán

Label: 3, with a score of: 0.695348163099159
WordScorePoS
include0VB
malnutrition0NN
infection0.122222546933424NN
substantial0JJ
evidence0NN
childhood0NN
disease0.215415047323213NN
inadequate0JJ
significant0.0127591822694525JJ
contributor0NN
child0.10682408961305NN

Label: 10, with a score of: 0.232990928067371
WordScorePoS
include0VB
malnutrition0NN
infection0NN
substantial0JJ
evidence0.12939607756667NN
childhood0NN
disease0NN
inadequate0JJ
significant0.0405241466500776JJ
contributor0NN
child0.0242343960710022NN

Label: 1, with a score of: 0.45269868286645
WordScorePoS
include0VB
malnutrition0.0736315832425121NN
infection0NN
substantial0.0736315832425121JJ
evidence0NN
childhood0NN
disease0NN
inadequate0.0736315832425121JJ
significant0.0376648791150643JJ
contributor0NN
child0.0450489732120807NN

Label: 6, with a score of: 0.355411485496824
WordScorePoS
include0VB
malnutrition0.041835863322702NN
infection0NN
substantial0JJ
evidence0NN
childhood0NN
disease0.103230094596636NN
inadequate0.0836717266454039JJ
significant0JJ
contributor0NN
child0.0255958462813622NN

Moreover the evidence indicates that malnutrition in turn increases the risk of child mortality and the incidence of morbidity and impairs cognitive development with consequences for educational attainment and performance see Fishman and others

Label: 3, with a score of: 0.751434408106338
WordScorePoS
evidence0NN
malnutrition0NN
increase0.0143984997539974NN
risk0.0703902516159815NN
child0.10682408961305NN
mortality0.276962203701274NN
incidence0.0407408489778079NN
development0.00837573444202498NN
educational0JJ
performance0NN

Label: 10, with a score of: 0.417731370447148
WordScorePoS
evidence0.12939607756667NN
malnutrition0NN
increase0.00285817158600878NN
risk0NN
child0.0242343960710022NN
mortality0.0488696285210061NN
incidence0NN
development0.0177346522508396NN
educational0JJ
performance0.064698038783335NN

WHO analysis in sought to incorporate this evidence of malnutritioninfection links in its environmental burden of disease methodology Fewtrell and others

Label: 3, with a score of: 0.625195493343879
WordScorePoS
seek0VB
evidence0NN
environmental0JJ
burden0NN
disease0.215415047323213NN

Label: 10, with a score of: 0.444566732370879
WordScorePoS
seek0VB
evidence0.12939607756667NN
environmental0.0237821918091848JJ
burden0NN
disease0NN

Label: 1, with a score of: 0.477351996339289
WordScorePoS
seek0.120266261535276VB
evidence0NN
environmental0.0442083771593746JJ
burden0NN
disease0NN

For the first time this methodology not only incorporated direct health risks from environmental factors such as diarrheal disease burden from poor water and sanitation but also sought to include indirect risks concentrating on WSH and its indirect effect on mortality through malnutrition

Label: 6, with a score of: 0.674548618324469
WordScorePoS
time0NN
direct0JJ
health0NN
risk0NN
environmental0JJ
disease0.103230094596636NN
burden0NN
poor0.0642010940957526JJ
water0.556409482163189NN
sanitation0.334686906581616NN
seek0VB
include0VB
effect0NN
mortality0NN
malnutrition0.041835863322702NN

Label: 3, with a score of: 0.552043156940898
WordScorePoS
time0.0127591822694525NN
direct0JJ
health0.191387734041787NN
risk0.0703902516159815NN
environmental0JJ
disease0.215415047323213NN
burden0NN
poor0JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
seek0VB
include0VB
effect0NN
mortality0.276962203701274NN
malnutrition0NN

Label: 1, with a score of: 0.302012833246833
WordScorePoS
time0NN
direct0JJ
health0NN
risk0.0519476926891779NN
environmental0.0442083771593746JJ
disease0NN
burden0NN
poor0.150659516460257JJ
water0NN
sanitation0NN
seek0.120266261535276VB
include0VB
effect0NN
mortality0NN
malnutrition0.0736315832425121NN

Label: 12, with a score of: 0.203325389514642
WordScorePoS
time0.0169905820958638NN
direct0JJ
health0.0339811641917276NN
risk0NN
environmental0.0598270388037045JJ
disease0NN
burden0NN
poor0.0339811641917276JJ
water0.186896403054502NN
sanitation0NN
seek0VB
include0VB
effect0NN
mortality0NN
malnutrition0NN

Thus while traditional burden of disease calculation would associate WSH with only diarrheal diseases see figure

Label: 3, with a score of: 0.874836388482687
WordScorePoS
traditional0JJ
burden0NN
disease0.215415047323213NN
figure0NN

Label: 6, with a score of: 0.419234609011063
WordScorePoS
traditional0JJ
burden0NN
disease0.103230094596636NN
figure0NN

the inclusion of the indirect path implies the need to include all diseases attributable to malnutrition because percent of the consequences of malnutrition are in turn attributed to poor WSH

Label: 1, with a score of: 0.629053086886789
WordScorePoS
inclusion0NN
include0VB
disease0NN
malnutrition0.0736315832425121NN
poor0.150659516460257JJ

Label: 3, with a score of: 0.454841165972647
WordScorePoS
inclusion0NN
include0VB
disease0.215415047323213NN
malnutrition0NN
poor0JJ

Label: 6, with a score of: 0.530194822555763
WordScorePoS
inclusion0NN
include0VB
disease0.103230094596636NN
malnutrition0.041835863322702NN
poor0.0642010940957526JJ

These additional diseases include ALRIs measles malaria protein energy malnutrition and other infectious diseases that cannot be directly attributed to environmental risk factors

Label: 3, with a score of: 0.745812818286368
WordScorePoS
additional0JJ
disease0.215415047323213NN
include0VB
measles0.0407408489778079NNS
malaria0.20370424488904NN
protein0NN
energy0NN
malnutrition0NN
environmental0JJ
risk0.0703902516159815NN

Label: 7, with a score of: 0.494714923127145
WordScorePoS
additional0JJ
disease0NN
include0VB
measles0NNS
malaria0NN
protein0NN
energy0.494617163780726NN
malnutrition0NN
environmental0JJ
risk0NN

Label: 12, with a score of: 0.193826328580853
WordScorePoS
additional0JJ
disease0NN
include0VB
measles0NNS
malaria0NN
protein0NN
energy0.133960988253756NN
malnutrition0NN
environmental0.0598270388037045JJ
risk0NN

Figure

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

illustrates these direct and indirect effects

Label: 9, with a score of: 0.493774432347703
WordScorePoS
direct0JJ
effect0.0454743001434393NN

Label: 11, with a score of: 0.486216175710825
WordScorePoS
direct0.04477822029736JJ
effect0NN

Label: 2, with a score of: 0.47850817635431
WordScorePoS
direct0JJ
effect0.0440683498519077NN

To quantify the health effects of malnutrition Fewtrell and others adopted the methodology of Blössner and de Onis who estimated fractions attributable to malnutrition for diarrheal diseases low birth weight lower respiratory infections malaria measles and protein energy malnutrition

Label: 3, with a score of: 0.787436781277969
WordScorePoS
health0.191387734041787NN
effect0NN
malnutrition0NN
adopt0VB
estimate0.059903311017139NN
disease0.215415047323213NN
birth0.0748292956291867NN
infection0.122222546933424NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
protein0NN
energy0NN

Label: 7, with a score of: 0.428846563000318
WordScorePoS
health0NN
effect0NN
malnutrition0NN
adopt0VB
estimate0NN
disease0NN
birth0NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN

Label: 12, with a score of: 0.177632279433815
WordScorePoS
health0.0339811641917276NN
effect0NN
malnutrition0NN
adopt0.0169905820958638VB
estimate0.0199423462679015NN
disease0NN
birth0NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN

Note that to avoid possible double counting Fewtrell and others did not include as an indirect effect diseases such as diarrhea that are direct effect of poor WSH even though diarrhea is one of the consequences of malnutrition

Label: 1, with a score of: 0.510352080448511
WordScorePoS
avoid0VB
double0RB
include0VB
effect0NN
disease0NN
direct0JJ
poor0.150659516460257JJ
malnutrition0.0736315832425121NN

Label: 3, with a score of: 0.490155506424488
WordScorePoS
avoid0VB
double0RB
include0VB
effect0NN
disease0.215415047323213NN
direct0JJ
poor0JJ
malnutrition0NN

Label: 6, with a score of: 0.476166354825311
WordScorePoS
avoid0VB
double0RB
include0VB
effect0NN
disease0.103230094596636NN
direct0JJ
poor0.0642010940957526JJ
malnutrition0.041835863322702NN

Therefore the estimates in Fewtrell and others are conservative

Label: 9, with a score of: 0.739177278219251
WordScorePoS
estimate0.0221298700466866NN
conservative0.0602029956716497JJ

Label: 3, with a score of: 0.537806694904204
WordScorePoS
estimate0.059903311017139NN
conservative0JJ

Environmental Health Burdens Results from the latest WHO analysis Fewtrell and others show the waterrelated WSH and water resource management or WRM environmental health burden for children under five years of age in various subregions see figure

Label: 6, with a score of: 0.563274590023742
WordScorePoS
environmental0JJ
health0NN
burden0NN
result0.0683326727248364NN
water0.556409482163189NN
resource0.0104991907358033NN
management0.0428007293971684NN
child0.0255958462813622NN
age0NN
figure0NN

Label: 3, with a score of: 0.504286557297983
WordScorePoS
environmental0JJ
health0.191387734041787NN
burden0NN
result0NN
water0.0382775468083574NN
resource0NN
management0.0127591822694525NN
child0.10682408961305NN
age0.0893142758861673NN
figure0NN

Label: 12, with a score of: 0.360371083834508
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
result0NN
water0.186896403054502NN
resource0.0416785799329393NN
management0.0339811641917276NN
child0NN
age0NN
figure0NN

From point of view of child health three subregions in Sub Saharan Africa and South Asia stand out in terms of the environmental health burden of disease

Label: 3, with a score of: 0.821880446289534
WordScorePoS
view0NN
child0.10682408961305NN
health0.191387734041787NN
saharan0.0299516555085695JJ
africa0IN
south0RB
asia0IN
stand0VB
term0NN
environmental0JJ
burden0NN
disease0.215415047323213NN

Label: 17, with a score of: 0.318279212028547
WordScorePoS
view0.048933054487825NN
child0NN
health0NN
saharan0JJ
africa0IN
south0RB
asia0IN
stand0.048933054487825VB
term0.149793392961411NN
environmental0JJ
burden0.036961556179878NN
disease0NN

An interesting feature of figure

Label: 9, with a score of: 0.749355860981293
WordScorePoS
feature0NN
figure0.0602029956716497NN

Label: 14, with a score of: 0.662167496644908
WordScorePoS
feature0.0531983120572613NN
figure0NN

is that regions differ widely from each other depending on whether one looks at DALYs per capita panel or total DALYs ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE

Label: 3, with a score of: 0.656337249662856
WordScorePoS
region0.124837844401518NN
widely0RB
depend0VB
capita0NN
panel0NN
total0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
figure0NN

Label: 1, with a score of: 0.424345750484671
WordScorePoS
region0.184259548107002NN
widely0RB
depend0VB
capita0NN
panel0NN
total0NN
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
figure0NN

The Health Effects of Environmental Risks Factors poor water inadequate sanitation improper personal and household hygiene indoor air pollution IAP inadequate water resource management WRM Diarrhea diarrhea Acute acute lower respiratory infections infections ALRIs malaria Malaria direct diarrhea WSH ALRI IAP malaria inadequate WRM tuberculosis IAP protein energy malnutrition WSH direct malnutrition from bad sanitation and repeated infections from food availability indirect diarrhea food ALRI non IAP infections not environmentally related excluding HIV Source Compiled by World Bank team

Label: 6, with a score of: 0.660311323926911
WordScorePoS
health0NN
effect0NN
environmental0JJ
risk0NN
poor0.0642010940957526JJ
water0.556409482163189NN
inadequate0.0836717266454039JJ
sanitation0.334686906581616NN
personal0JJ
household0NN
hygiene0.136665345449673NN
air0NN
pollution0.0590310971343993NN
resource0.0104991907358033NN
management0.0428007293971684NN
infection0NN
malaria0NN
direct0JJ
tuberculosis0NN
protein0NN
energy0.0153390539205676NN
malnutrition0.041835863322702NN
bad0.0683326727248364JJ
food0.0214003646985842NN
availability0NN
environmentally0RB
related0.0524959536790166JJ
hiv0NN
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 3, with a score of: 0.53418829345299
WordScorePoS
health0.191387734041787NN
effect0NN
environmental0JJ
risk0.0703902516159815NN
poor0JJ
water0.0382775468083574NN
inadequate0JJ
sanitation0.0249430985430622NN
personal0JJ
household0NN
hygiene0NN
air0.020806307400253NN
pollution0.0175975629039954NN
resource0NN
management0.0127591822694525NN
infection0.122222546933424NN
malaria0.20370424488904NN
direct0JJ
tuberculosis0.162963395911232NN
protein0NN
energy0NN
malnutrition0NN
bad0JJ
food0NN
availability0NN
environmentally0RB
related0.0125195145191824JJ
hiv0.448149338755887NN
source0NN
world0.00087176582269799NN
bank0NN

Label: 12, with a score of: 0.317588258778936
WordScorePoS
health0.0339811641917276NN
effect0NN
environmental0.0598270388037045JJ
risk0NN
poor0.0339811641917276JJ
water0.186896403054502NN
inadequate0JJ
sanitation0NN
personal0.0542519672965169JJ
household0.0554128417527413NN
hygiene0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
resource0.0416785799329393NN
management0.0339811641917276NN
infection0NN
malaria0NN
direct0JJ
tuberculosis0NN
protein0NN
energy0.133960988253756NN
malnutrition0NN
bad0JJ
food0.186896403054502NN
availability0NN
environmentally0RB
related0.00833571598658786JJ
hiv0NN
source0NN
world0.00464349782489754NN
bank0NN

Label: 2, with a score of: 0.242330913704184
WordScorePoS
health0NN
effect0.0440683498519077NN
environmental0JJ
risk0.0252000451111224NN
poor0.0548141757796873JJ
water0NN
inadequate0JJ
sanitation0NN
personal0JJ
household0.0297950283197006NN
hygiene0NN
air0NN
pollution0NN
resource0.0358563662904843NN
management0NN
infection0NN
malaria0NN
direct0JJ
tuberculosis0NN
protein0NN
energy0.0130963126055467NN
malnutrition0.0357189919948307NN
bad0JJ
food0.292342270824999NN
availability0NN
environmentally0RB
related0.00896409157262106JJ
hiv0NN
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 1, with a score of: 0.181923949403355
WordScorePoS
health0NN
effect0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
poor0.150659516460257JJ
water0NN
inadequate0.0736315832425121JJ
sanitation0NN
personal0JJ
household0NN
hygiene0NN
air0NN
pollution0NN
resource0.0739147683583536NN
management0NN
infection0NN
malaria0NN
direct0JJ
tuberculosis0NN
protein0NN
energy0NN
malnutrition0.0736315832425121NN
bad0JJ
food0NN
availability0NN
environmentally0RB
related0.0184786920895884JJ
hiv0NN
source0.0269969049497485NN
world0.00257343720272548NN
bank0NN

Label: 7, with a score of: 0.148461946338014
WordScorePoS
health0NN
effect0NN
environmental0JJ
risk0NN
poor0JJ
water0NN
inadequate0JJ
sanitation0NN
personal0JJ
household0NN
hygiene0NN
air0NN
pollution0NN
resource0NN
management0NN
infection0NN
malaria0NN
direct0JJ
tuberculosis0NN
protein0NN
energy0.494617163780726NN
malnutrition0NN
bad0JJ
food0.0383371018038178NN
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environmentally0RB
related0JJ
hiv0NN
source0.0274787313211514NN
world0.00261936653839306NN
bank0NN

panel

Label: 13, with a score of: 1
WordScorePoS
panel0.0548233071065585NN

Although the Southeast Asian subregion SEARD has similar number of DALYs as the African subregion AFRD the two subregions differ quite substantially in terms of DALYs per capita with the latter having value more than two times higher

Label: 17, with a score of: 0.694799963527006
WordScorePoS
african0IN
substantially0RB
term0.149793392961411NN
capita0NN
time0NN

Incidentally diarrheal disease in SEARD is in relative terms more important as percentage of total DALYs than diarrheal disease in AFRD

Label: 3, with a score of: 0.790752941330139
WordScorePoS
disease0.215415047323213NN
relative0JJ
term0NN
percentage0NN
total0NN

Label: 17, with a score of: 0.274933361313272
WordScorePoS
disease0NN
relative0JJ
term0.149793392961411NN
percentage0NN
total0NN

Label: 6, with a score of: 0.433113914360555
WordScorePoS
disease0.103230094596636NN
relative0JJ
term0NN
percentage0NN
total0.0295155485671997NN

When compared with the most developed subregion EURA which is in Europe the environmental health burden in DALYs per children under five in the two subregions of Africa AFRB and AFRD is about to times higher

Label: 3, with a score of: 0.735798850660432
WordScorePoS
compare0.0307735781890304VB
develop0VB
environmental0JJ
health0.191387734041787NN
burden0NN
child0.10682408961305NN
africa0IN
time0.0127591822694525NN

For SEARD this ratio is about times higher

Label: 3, with a score of: 0.597285442677786
WordScorePoS
ratio0.0615471563780609NN
time0.0127591822694525NN

Label: 5, with a score of: 0.55355674008976
WordScorePoS
ratio0.0688661930304451NN
time0NN

Label: 10, with a score of: 0.488608710473204
WordScorePoS
ratio0NN
time0.0607862199751165NN

Important risk factors such as indoor air pollution and environmental attributable perinatal mortality are not included in figure

Label: 3, with a score of: 0.789681391625554
WordScorePoS
risk0.0703902516159815NN
air0.020806307400253NN
pollution0.0175975629039954NN
environmental0JJ
mortality0.276962203701274NN
include0VB
figure0NN

Label: 11, with a score of: 0.380546831418751
WordScorePoS
risk0.0631828116343571NN
air0.0373517915079663NN
pollution0.0315914058171786NN
environmental0.0537696560159885JJ
mortality0NN
include0VB
figure0NN

In the public imagination the home of the malnourished child is SubSaharan Africa

Label: 3, with a score of: 0.534804491049405
WordScorePoS
public0.021678073222951NN
child0.10682408961305NN
africa0IN

Label: 5, with a score of: 0.373912628510134
WordScorePoS
public0.0727679293221751NN
child0.0170753354211044NN
africa0IN

Label: 16, with a score of: 0.370374561915044
WordScorePoS
public0.0285977592242194NN
child0.0603953832457135NN
africa0IN

Label: 11, with a score of: 0.356965479538433
WordScorePoS
public0.0583751976558017NN
child0.0273960270556257NN
africa0IN

Label: 4, with a score of: 0.317658347813375
WordScorePoS
public0NN
child0.076326555629389NN
africa0IN

Nevertheless some researchers showed evidence that the HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

Label: 10, with a score of: 0.570682029998361
WordScorePoS
researcher0NN
evidence0.12939607756667NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN

Label: 3, with a score of: 0.563862562071147
WordScorePoS
researcher0NN
evidence0NN
environmental0JJ
health0.191387734041787NN
burden0NN

Label: 12, with a score of: 0.436211794760476
WordScorePoS
researcher0.0542519672965169NN
evidence0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN

FIGURE

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

Water Related WSH plus WRM Burden of Disease in Children under Five Attributable to Environmental Risk Factors by WHO Region a

Label: 6, with a score of: 0.68708173778981
WordScorePoS
water0.556409482163189NN
related0.0524959536790166JJ
burden0NN
disease0.103230094596636NN
child0.0255958462813622NN
environmental0JJ
risk0NN
region0NN

Label: 3, with a score of: 0.529249576688101
WordScorePoS
water0.0382775468083574NN
related0.0125195145191824JJ
burden0NN
disease0.215415047323213NN
child0.10682408961305NN
environmental0JJ
risk0.0703902516159815NN
region0.124837844401518NN

Label: 1, with a score of: 0.320329534866907
WordScorePoS
water0NN
related0.0184786920895884JJ
burden0NN
disease0NN
child0.0450489732120807NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
region0.184259548107002NN

Label: 12, with a score of: 0.237547832369982
WordScorePoS
water0.186896403054502NN
related0.00833571598658786JJ
burden0NN
disease0NN
child0NN
environmental0.0598270388037045JJ
risk0NN
region0NN

DALYs per capita WPRB SEARD SEARB WHO region diarrheal diseases EMRD malnutrition and its consequences EMRB malaria AMRD other AMRB AFRE AFRD

Label: 3, with a score of: 0.865019433575085
WordScorePoS
capita0NN
region0.124837844401518NN
disease0.215415047323213NN
malnutrition0NN
malaria0.20370424488904NN

Label: 1, with a score of: 0.410107387785575
WordScorePoS
capita0NN
region0.184259548107002NN
disease0NN
malnutrition0.0736315832425121NN
malaria0NN

DALYs per children under

Label: 3, with a score of: 0.614417683772385
WordScorePoS
child0.10682408961305NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
child0.076326555629389NN

Label: 16, with a score of: 0.347374750571648
WordScorePoS
child0.0603953832457135NN

Label: 2, with a score of: 0.314234936000714
WordScorePoS
child0.0546336178945768NN

Total DALYs WPRB SEARD WHO region SEARB diarrheal diseases EMRD malnutrition and its consequences EMRB malaria other WSH AMRD AMRB AFRE AFRD DALYs Sources Adapted from Fewtrell and others Prüss Üstün and Corvalán

Label: 3, with a score of: 0.804421644845752
WordScorePoS
total0NN
region0.124837844401518NN
disease0.215415047323213NN
malnutrition0NN
malaria0.20370424488904NN
source0NN

Label: 1, with a score of: 0.421301766869635
WordScorePoS
total0NN
region0.184259548107002NN
disease0NN
malnutrition0.0736315832425121NN
malaria0NN
source0.0269969049497485NN

Note Calculations are based on deaths attributable to perinatal conditions published in Graham and others and on estimating the regional aggregate number of live births using live birth per data population data from the World Bank Development Data Platform and Live Database time series for

Label: 3, with a score of: 0.533146826926496
WordScorePoS
base0.0149758277542848NN
death0.193573191943949NN
condition0NN
estimate0.059903311017139NN
regional0JJ
live0.0300513417930436VB
birth0.0748292956291867NN
datum0NN
population0NN
world0.00087176582269799NN
bank0NN
development0.00837573444202498NN
platform0NN
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The WHO regions are defined as follows WPRB Western Pacific subregion with low child and low adult mortality SEARD Southeast Asian subregion with high child and high adult mortality SEARB Southeast Asian subregion with low child and low adult mortality EMRD Eastern Mediterranean subregion with high child and high adult mortality EMRB Eastern Mediterranean subregion with low child and low adult mortality AMRD subregion of the Americas with high child and high adult mortality AMRB subregion of the Americas with low child and low adult mortality AFRE African subregion with high child and very high adult mortality AFRD African subregion with high child and high adult mortality

Label: 3, with a score of: 0.822897036273618
WordScorePoS
region0.124837844401518NN
western0JJ
child0.10682408961305NN
adult0JJ
mortality0.276962203701274NN
eastern0.0407408489778079JJ
african0IN

Label: 4, with a score of: 0.484257079482629
WordScorePoS
region0NN
western0JJ
child0.076326555629389NN
adult0.163013873070017JJ
mortality0NN
eastern0JJ
african0IN

Label: 1, with a score of: 0.132571069026489
WordScorePoS
region0.184259548107002NN
western0JJ
child0.0450489732120807NN
adult0JJ
mortality0NN
eastern0JJ
african0IN

For detailed list of the countries that belong to each subregion see http www

Label: 1, with a score of: 1
WordScorePoS
country0NN
belong0.120266261535276VB

int choice demography regions en index

Label: 1, with a score of: 0.772217698392253
WordScorePoS
choice0NN
region0.184259548107002NN

Label: 3, with a score of: 0.523185874850884
WordScorePoS
choice0NN
region0.124837844401518NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL worst affected region is not Africa but South Asia Ramalingaswami Jonsson and Rohde

Label: 3, with a score of: 0.700475372588537
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
worst0JJS
affect0.00625975725959118VB
region0.124837844401518NN
africa0IN
south0RB
asia0IN

Label: 1, with a score of: 0.476429605399032
WordScorePoS
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
worst0JJS
affect0.0184786920895884VB
region0.184259548107002NN
africa0IN
south0RB
asia0IN

Over the past few decades other explanations have been suggested for these surprising results which have been labeled the Asian enigma see box

Label: 13, with a score of: 0.720593189311826
WordScorePoS
decade0.124232265906675NN
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result0NN
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BOX

Label: 0, with a score of: 1

Revisiting the Asian Enigma As many as percent of children in India are born with low birth weight as compared with only percent in Sub Saharan Africa

Label: 3, with a score of: 0.814358380918068
WordScorePoS
child0.10682408961305NN
bear0.0814816979556159NN
birth0.0748292956291867NN
compare0.0307735781890304VB
saharan0.0299516555085695JJ
africa0IN

Furthermore continuing up to five years of age underweight rates remain far lower in Sub Saharan Africa approximately percent compared with those in South Asia close to percent

Label: 1, with a score of: 0.573833485906526
WordScorePoS
continue0VB
age0.112994637345193NN
rate0.0639932865717261NN
remain0VB
saharan0.0442083771593746JJ
africa0IN
approximately0RB
compare0VB
south0RB
asia0IN

Label: 3, with a score of: 0.501712293192494
WordScorePoS
continue0VB
age0.0893142758861673NN
rate0.0433561464459019NN
remain0VB
saharan0.0299516555085695JJ
africa0IN
approximately0RB
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asia0IN

Although the depth of hunger is clearly greatest in Sub Saharan Africa FAO and the gross domestic product and living standards are higher in South Asian countries this nutritional status difference is considered to be somewhat of an enigma Gragnolati and others

Label: 2, with a score of: 0.598822755666405
WordScorePoS
hunger0.214313951968984NN
saharan0.0214456704626236JJ
africa0IN
gross0JJ
domestic0JJ
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live0.0143446978608332VB
standard0NN
south0RB
country0NN
nutritional0.0583416713841148JJ
status0NN

Label: 9, with a score of: 0.392202913864779
WordScorePoS
hunger0NN
saharan0.0221298700466866JJ
africa0IN
gross0.030745604615229JJ
domestic0.0520080474473126JJ
product0.0442597400933733NN
live0.00740117451847634VB
standard0.0454743001434393NN
south0RB
country0NN
nutritional0JJ
status0NN

Label: 1, with a score of: 0.372297703159173
WordScorePoS
hunger0.0736315832425121NN
saharan0.0442083771593746JJ
africa0IN
gross0JJ
domestic0JJ
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live0.0739258553811849VB
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nutritional0JJ
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Using multivariate analyses of household survey data Ramalingaswami Jonsson and Rohde suggested that this difference was explained by the better decision making power of women in Sub Saharan Africa compared with those in Asia but they also stated that sanitation differences use of latrine between the regions clearly contribute to the nutritional status gap as well

Label: 6, with a score of: 0.480902348892765
WordScorePoS
household0NN
survey0NN
datum0NN
suggest0VB
decision0NN
power0NN
woman0.0127979231406811NN
saharan0JJ
africa0IN
compare0VB
asia0IN
sanitation0.334686906581616NN
latrine0.0683326727248364NN
region0NN
contribute0VB
nutritional0JJ
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gap0NN

Label: 5, with a score of: 0.448725465457716
WordScorePoS
household0.0465610847355851NN
survey0NN
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suggest0VB
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power0NN
woman0.221979360474357NN
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africa0IN
compare0VB
asia0IN
sanitation0NN
latrine0NN
region0.0465610847355851NN
contribute0VB
nutritional0JJ
status0NN
gap0NN

Label: 1, with a score of: 0.376407162884728
WordScorePoS
household0NN
survey0NN
datum0NN
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woman0.0450489732120807NN
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asia0IN
sanitation0NN
latrine0NN
region0.184259548107002NN
contribute0VB
nutritional0JJ
status0NN
gap0NN

Label: 9, with a score of: 0.355285592127574
WordScorePoS
household0NN
survey0NN
datum0.0454743001434393NN
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power0.0454743001434393NN
woman0NN
saharan0.0221298700466866JJ
africa0IN
compare0VB
asia0IN
sanitation0.0737171311497939NN
latrine0NN
region0NN
contribute0VB
nutritional0JJ
status0NN
gap0.0602029956716497NN

Scientific inference from household surveys is often hampered by issues of confounding other related factors ultimately may be the culprit as well as by inconsistencies in definitions what is meant by latrine in different countries

Label: 0, with a score of: 1

Cairncross and Kolsky

Label: 0, with a score of: 1

Also for example high latrine use might significantly threaten the integrity of sources of drinking water again making inferences difficult Kimani Murage and Ngindu

Label: 6, with a score of: 0.963872016247565
WordScorePoS
latrine0.0683326727248364NN
significantly0RB
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source0.0613562156822703NN
drinking0.206460189193271NN
water0.556409482163189NN

Label: 12, with a score of: 0.201829012641231
WordScorePoS
latrine0NN
significantly0RB
threaten0VB
source0NN
drinking0NN
water0.186896403054502NN

Often serious problems with data quality exist for example in recent Kenya National Census the enumerators missed Kibera the largest shantytown in Africa which led to overestimating latrine use in Kenya

Label: 0, with a score of: 1

Finally mechanisms of causality often remain obscure in studies relying on indicator data Cairncross and Kolsky Kolsky and Blumenthal

Label: 17, with a score of: 0.820085906234887
WordScorePoS
mechanism0.147846224719512NN
remain0VB
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If sanitation and hygiene conditions were poorer in South Asia one might logically expect more diarrhea per child which is not the case see figure

Label: 6, with a score of: 0.854774729123651
WordScorePoS
sanitation0.334686906581616NN
hygiene0.136665345449673NN
condition0NN
south0RB
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expect0VB
child0.0255958462813622NN
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In attempting to explain this enigma researchers have not adequately considered the intergenerational dimensions of malnutrition that is malnourished fetuses result in babies with low birth weight

Label: 1, with a score of: 0.810216090346115
WordScorePoS
researcher0NN
dimension0.181686110904276NN
malnutrition0.0736315832425121NN
result0NN
birth0NN

These babies become underweight mothers and in turn give birth to more babies with low birth weight

Label: 3, with a score of: 0.897493420467221
WordScorePoS
mother0.162963395911232NN
birth0.0748292956291867NN

The prevalence of fetal undernutrition or restricted growth in utero is directly related to the duration and incidence of malnutrition which is increased by mother low weight before pregnancy and by infections during pregnancy such as hookworms and malaria

Label: 3, with a score of: 0.875605310237782
WordScorePoS
prevalence0.0407408489778079NN
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increase0.0143984997539974NN
mother0.162963395911232NN
infection0.122222546933424NN
malaria0.20370424488904NN

Label: 8, with a score of: 0.334299974441818
WordScorePoS
prevalence0NN
growth0.208565600657229NN
related0.0123650647908625JJ
incidence0NN
malnutrition0NN
increase0.00711043475673939NN
mother0NN
infection0NN
malaria0NN

continued HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

Label: 3, with a score of: 0.615138994238776
WordScorePoS
continue0VB
environmental0JJ
health0.191387734041787NN
burden0NN

Label: 11, with a score of: 0.419262364827591
WordScorePoS
continue0.0537696560159885VB
environmental0.0537696560159885JJ
health0.0229054731708393NN
burden0NN

Label: 12, with a score of: 0.365605449159442
WordScorePoS
continue0.0199423462679015VB
environmental0.0598270388037045JJ
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burden0NN

number of miscarriages stillbirths and perinatal deaths owed in large part to rampant malaria likely are preferentially harvesting the underweight fetuses and children from the African population Adjuik and others van Geertruyden and others

Label: 3, with a score of: 0.86577917960737
WordScorePoS
death0.193573191943949NN
malaria0.20370424488904NN
harvest0NN
child0.10682408961305NN
african0IN
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These early deaths then do not add to the statistics of underweight children and therefore the region appears to have fewer underweight babies than does South Asia

Label: 3, with a score of: 0.790165697164681
WordScorePoS
death0.193573191943949NN
add0VB
child0.10682408961305NN
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south0RB
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Label: 1, with a score of: 0.426097743467154
WordScorePoS
death0NN
add0VB
child0.0450489732120807NN
region0.184259548107002NN
south0RB
asia0IN

The Multiplier Effect for Environmental Health Interventions Results from these subregional data show the multiplier effect of environmental health interventions on mortality where investments addressing environmental risks for example lack of water and sanitation not only reduce diarrhea mortality but also reduce mortality from malnutrition related diseases and its consequences on educational attainment

Label: 3, with a score of: 0.714676580503591
WordScorePoS
effect0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
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datum0NN
mortality0.276962203701274NN
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risk0.0703902516159815NN
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sanitation0.0249430985430622NN
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malnutrition0NN
related0.0125195145191824JJ
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educational0JJ

Label: 6, with a score of: 0.535081775358205
WordScorePoS
effect0NN
environmental0JJ
health0NN
intervention0NN
result0.0683326727248364NN
datum0NN
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lack0.0214003646985842NN
water0.556409482163189NN
sanitation0.334686906581616NN
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malnutrition0.041835863322702NN
related0.0524959536790166JJ
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educational0.0683326727248364JJ

Label: 12, with a score of: 0.206044161691655
WordScorePoS
effect0NN
environmental0.0598270388037045JJ
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intervention0NN
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lack0NN
water0.186896403054502NN
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reduce0.022306853314744VB
malnutrition0NN
related0.00833571598658786JJ
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educational0JJ

In these subregions this multiplier ranges from

Label: 9, with a score of: 0.661219646565177
WordScorePoS
range0.0368585655748969NN

Label: 13, with a score of: 0.602133620496952
WordScorePoS
range0.0335649154577099NN

figure

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

which means for every direct death avoided FIGURE

Label: 3, with a score of: 0.729816853898752
WordScorePoS
means0NNS
direct0JJ
death0.193573191943949NN
avoid0VB
figure0NN

Label: 1, with a score of: 0.453432336070869
WordScorePoS
means0.120266261535276NNS
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Mills Reincke Ratios for Subregions

Label: 5, with a score of: 0.745617614204109
WordScorePoS
ratio0.0688661930304451NN

Label: 3, with a score of: 0.666374049156008
WordScorePoS
ratio0.0615471563780609NN

AFRD

Label: 0, with a score of: 1

SEARD Mills Reincke ratio

Label: 5, with a score of: 0.745617614204109
WordScorePoS
ratio0.0688661930304451NN

Label: 3, with a score of: 0.666374049156008
WordScorePoS
ratio0.0615471563780609NN

EURC

Label: 0, with a score of: 1

WPRB EURB AFRE EMRD SEARB

Label: 0, with a score of: 1

AMRD

Label: 0, with a score of: 1

AMRB EMRB

Label: 0, with a score of: 1

EURA

Label: 0, with a score of: 1

diarrheal mortality Source Compiled by World Bank team on the basis of Fewtrell and others

Label: 3, with a score of: 0.833476562477327
WordScorePoS
mortality0.276962203701274NN
source0NN
world0.00087176582269799NN
bank0NN
basis0NN

Label: 2, with a score of: 0.341140220482974
WordScorePoS
mortality0NN
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN
basis0NN

Label: 17, with a score of: 0.303192255062981
WordScorePoS
mortality0NN
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN
basis0.048933054487825NN

Note The World Health Organization regions are defined as follows WPRB Western Pacific subregion with low child and low adult mortality SEARD Southeast Asian subregion with high child and high adult mortality SEARB Southeast Asian subregion with low child and low adult mortality EMRD Eastern Mediterranean subregion with high child and high adult mortality EMRB Eastern Mediterranean subregion with low child and low adult mortality AMRD subregion of the Americas with high child and high adult mortality AMRB subregion of the Americas with low child and low adult mortality AFRE African subregion with high child and very high adult mortality AFRD African subregion with high child and high adult mortality EURA Europe subregion with very low child and very low adult mortality EURB Europe subregion with low child and low adult mortality EURC Europe with low child and high adult mortality

Label: 3, with a score of: 0.828975617492268
WordScorePoS
world0.00087176582269799NN
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western0JJ
child0.10682408961305NN
adult0JJ
mortality0.276962203701274NN
eastern0.0407408489778079JJ
african0IN

Label: 4, with a score of: 0.47441624118339
WordScorePoS
world0.0017440716962658NN
health0NN
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western0JJ
child0.076326555629389NN
adult0.163013873070017JJ
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eastern0JJ
african0IN

Label: 1, with a score of: 0.120083745816567
WordScorePoS
world0.00257343720272548NN
health0NN
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western0JJ
child0.0450489732120807NN
adult0JJ
mortality0NN
eastern0JJ
african0IN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL from an environmental health intervention at least half to almost one additional death is averted from indirect links

Label: 3, with a score of: 0.873224018851046
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
intervention0.0407408489778079NN
additional0JJ
death0.193573191943949NN
avert0.0814816979556159VB

A recent research paper using household survey data for rural China similarly found evidence of

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WordScorePoS
research0NN
household0.0330412182586772NN
survey0.064698038783335NN
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evidence0.12939607756667NN

Label: 2, with a score of: 0.530064907871106
WordScorePoS
research0.0252000451111224NN
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Label: 9, with a score of: 0.388486193741935
WordScorePoS
research0.104016094894625NN
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multiplier implying that for every diarrheal death averted in children under five from household water connections an additional ALRI death was also averted Jacoby and Wang

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WordScorePoS
death0.193573191943949NN
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child0.10682408961305NN
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Label: 6, with a score of: 0.626051439231725
WordScorePoS
death0.0295155485671997NN
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child0.0255958462813622NN
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Label: 12, with a score of: 0.236644978970924
WordScorePoS
death0NN
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child0NN
household0.0554128417527413NN
water0.186896403054502NN
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This multiplier effect is not new it was first empirically observed in the late th century and came to be known as the Mills Reincke phenomenon see box

Label: 13, with a score of: 0.960746134675742
WordScorePoS
effect0NN
century0.219293228426234NN

BOX

Label: 0, with a score of: 1

The Mills Reincke Phenomenon In the late th century impressed by the beneficial effects of clean water supply on mortality especially child mortality German sanitary engineer Johann Julius Reincke and an American sanitary engineer Hiram F

Label: 3, with a score of: 0.660718326097124
WordScorePoS
century0NN
effect0NN
clean0.020806307400253JJ
water0.0382775468083574NN
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mortality0.276962203701274NN
child0.10682408961305NN

Label: 6, with a score of: 0.62042485237086
WordScorePoS
century0NN
effect0NN
clean0.0348974218717993JJ
water0.556409482163189NN
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child0.0255958462813622NN

Label: 12, with a score of: 0.236075512285531
WordScorePoS
century0NN
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supply0.0703006268489394NN
mortality0NN
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Label: 13, with a score of: 0.201284444306791
WordScorePoS
century0.219293228426234NN
effect0NN
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water0NN
supply0NN
mortality0NN
child0NN

Label: 7, with a score of: 0.163296844565653
WordScorePoS
century0NN
effect0NN
clean0.125032076213024JJ
water0NN
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Mills independently found that for every prevented death from waterborne diseases additional pulmonary tuberculosis pneumonia and infant deaths were averted

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WordScorePoS
prevent0VB
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tuberculosis0.162963395911232NN
infant0NN
avert0.0814816979556159VB

This curiosity came to be called the Mills Reincke phenomenon Sedgwick and Macnutt

Label: 0, with a score of: 1

recent analysis of several U

Label: 0, with a score of: 1

cities for to has conservatively estimated that for one diarrhea death three other deaths were averted by clean water supply systems Cutler and Miller

Label: 11, with a score of: 0.595472703944018
WordScorePoS
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avert0VB
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Label: 6, with a score of: 0.56450620262058
WordScorePoS
city0NN
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avert0VB
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Label: 3, with a score of: 0.467616157115104
WordScorePoS
city0NN
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Label: 12, with a score of: 0.220543715835959
WordScorePoS
city0NN
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avert0VB
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WordScorePoS
city0NN
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Mortality declined steeply without major advances in curative and individually targeted preventive interventions for example vaccines Cutler and Miller

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WordScorePoS
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Another important source of typhoid fever killing especially children under five years of age from unclean milk was also eliminated in the early decades of the st century Rosen

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WordScorePoS
source0.0123065238088614NN
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WordScorePoS
source0NN
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WordScorePoS
source0.0269969049497485NN
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The explanations behind the Mills Reincke phenomenon have remained enigmatic Cairncross

Label: 0, with a score of: 1

Contemporaries Sedgwick and Macnutt considered two alternatives that the other category would ultimately also be waterborne or that clean water supply somehow enhanced vitality it was known that after convalescence typhoid fever patients suffered greatly from secondary infections Ferrie and Troesken as cited in Cutler and Miller

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WordScorePoS
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WordScorePoS
alternative0NN
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WordScorePoS
alternative0NN
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Evidence to support the first explanation still has not been found

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WordScorePoS
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Label: 17, with a score of: 0.303768249159526
WordScorePoS
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The results derived from Fewtrell and others are in line with the second explanation and bring together current competing nutrition and infection based models Cutler and Miller for explaining the dramatically lowered mortality rates in the developed countries over the past century

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WordScorePoS
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WordScorePoS
result0NN
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WordScorePoS
result0NN
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Recent research has revealed that unintentional consequences of improved hygienic conditions include steep decline in stomach cancer Kivi and Tindberg Parkin and potential for decreased susceptibility to coronary heart disease Eriksson

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WordScorePoS
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HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

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WordScorePoS
environmental0JJ
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burden0NN

Label: 12, with a score of: 0.357899080308486
WordScorePoS
environmental0.0598270388037045JJ
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Conservative Estimates The Mills Reincke ratios the ratio of consequences of malnutrition diarrhea deaths in subregional WHO estimates are plotted on graph with decreasing level of development using increased risk of diarrheal deaths as proxy reflecting the close correlation between diarrheal disease and malnutrition see figure

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WordScorePoS
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These ratios are small ranging from

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WordScorePoS
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Label: 5, with a score of: 0.567839000484058
WordScorePoS
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Label: 9, with a score of: 0.303918804195736
WordScorePoS
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when compared to those conservatively derived

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WordScorePoS
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Label: 3, with a score of: 0.596465163910542
WordScorePoS
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for the United States during the early th century

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WordScorePoS
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One explanation for the relatively more conservative ratios might be current child survival interventions such as measles vaccinations

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WordScorePoS
conservative0JJ
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Although current methodologies to estimate burdens attributable to environmental health use the best available information the impacts of environmental risk factors are considerably underestimated for several reasons

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WordScorePoS
current0JJ
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Label: 12, with a score of: 0.538198925311565
WordScorePoS
current0.0332151194779746JJ
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Label: 11, with a score of: 0.34759755000388
WordScorePoS
current0JJ
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environmental0.0537696560159885JJ
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Label: 9, with a score of: 0.306163417760504
WordScorePoS
current0JJ
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The health impacts from environmental risk factors are potentially underestimated in several areas

Label: 3, with a score of: 0.658103625725549
WordScorePoS
health0.191387734041787NN
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Label: 12, with a score of: 0.453546670036354
WordScorePoS
health0.0339811641917276NN
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Label: 11, with a score of: 0.400517487190756
WordScorePoS
health0.0229054731708393NN
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The first is in the area of perinatal deaths

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WordScorePoS
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The percent of these deaths considered to be attributable to the environment in developing countries is likely to be substantial underestimate Prüss Üstün and Corvalán

Label: 3, with a score of: 0.708493799852532
WordScorePoS
death0.193573191943949NN
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Breman Alilio and Mills suggest that as many as about percent of perinatal deaths could be attributable to rampant malaria in Sub Saharan Africa

Label: 3, with a score of: 0.956559327537274
WordScorePoS
suggest0VB
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Second growing evidence Jefferson and others shows that ALRIs can be prevented by improving personal and household practices implying that the WSH attributable health burden becomes substantially larger Cairncross and Valdmanis

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WordScorePoS
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Label: 3, with a score of: 0.373356626085486
WordScorePoS
grow0VB
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Label: 12, with a score of: 0.483654159178795
WordScorePoS
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For example randomized clinical trial in Karachi Pakistan showed that hand washing reduces ALRIs by percent Luby and others

Label: 0, with a score of: 1

Third substantial proportion of ALRI deaths associated with indoor air pollution would not have occurred had the children not been malnourished Ezzati Vander Hoorn and others

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WordScorePoS
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However only some of these deaths are included in the consequences of malnutrition

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WordScorePoS
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Label: 1, with a score of: 0.31440070628833
WordScorePoS
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Label: 6, with a score of: 0.304664565190318
WordScorePoS
death0.0295155485671997NN
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Finally malaria deaths that are attributable to inadequate mosquito habitat control for example percent in Sub Saharan Africa do not include the fraction that can be effectively prevented by other environmental management measures such as indoor residual spraying and bednets

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WordScorePoS
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WordScorePoS
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Similarly there are several indications that the malnutrition mediated effects of environmental risk factors consequences of malnutrition are underestimated

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WordScorePoS
malnutrition0.0736315832425121NN
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Label: 11, with a score of: 0.345212681851939
WordScorePoS
malnutrition0NN
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First the consequences of malnutrition in Fewtrell and others consider only attributable fractions of moderate and severe maternal and childhood underweight less than or equal to standard deviations SD but do not include the consequences of mild malnutrition from SD to SD

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WordScorePoS
malnutrition0NN
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Mild malnutrition the health burden of which is included in other estimates is the most prevalent form of malnutrition and increases death risk almost twofold Caulfield and others Fishman and others

Label: 3, with a score of: 0.72338298345189
WordScorePoS
malnutrition0NN
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Label: 16, with a score of: 0.27927032040879
WordScorePoS
malnutrition0NN
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Label: 1, with a score of: 0.392832525708718
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Second percent of malaria deaths in Sub Saharan Africa are caused by poor WRM

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WordScorePoS
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Label: 1, with a score of: 0.38302326424167
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malaria0NN
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Of the remaining ENVIRONMENTAL HEALTH AND CHILD SURVIVAL percent of malaria deaths caused from other factors however at least portion should be attributable to environmental factors through the effect of diarrheal infections on malnutrition and increased malaria fatality rates see figure

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WordScorePoS
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They are not included because some of these deaths would overlap with those directly attributable to inadequate habitat control

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WordScorePoS
include0VB
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Label: 1, with a score of: 0.449600524490699
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Label: 6, with a score of: 0.376812428548214
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Third given the price and wage inelasticity among the poorest income spent on environmental health services such as water often takes away from food budgets thereby contributing to malnutrition

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WordScorePoS
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Label: 12, with a score of: 0.457351113903831
WordScorePoS
price0NN
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Label: 10, with a score of: 0.290526531344975
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Label: 3, with a score of: 0.206951936358671
WordScorePoS
price0NN
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In Khartoum Sudan for example residents of one squatter settlement were found to pay as much as percent of their income to purchase water Cairncross and Kinnear sacrificed at the cost of their food budgets

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WordScorePoS
settlement0NN
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Label: 12, with a score of: 0.440122322831472
WordScorePoS
settlement0NN
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Label: 2, with a score of: 0.390990825491948
WordScorePoS
settlement0NN
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Label: 10, with a score of: 0.285563080317242
WordScorePoS
settlement0NN
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Label: 11, with a score of: 0.245196843231007
WordScorePoS
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final point on why these current estimates are conservative involves the longer term perspective

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Label: 12, with a score of: 0.711044338532795
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The Barker or fetal programming hypothesis mentioned in box

Label: 0, with a score of: 1

postulates that malnourishment in utero or very early in infanthood makes adults more susceptible to chronic diseases like coronary heart disease later in life Eriksson

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This hypothesis means that current poor environmental health conditions in early childhood will result in higher future health effects in terms of chronic diseases Eriksson

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Label: 17, with a score of: 0.185324473931607
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Label: 6, with a score of: 0.341310220652199
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Areas for Future Research Given the importance of protecting the fetus from malnutrition and subsequent growth faltering researchers need to pay more attention to quantifying environmental health problems during pregnancy

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growth0NN
researcher0NN
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Label: 11, with a score of: 0.398003371753017
WordScorePoS
future0.0373517915079663NN
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protect0.0328357290160445VB
malnutrition0NN
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researcher0NN
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Label: 10, with a score of: 0.361819875555267
WordScorePoS
future0NN
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malnutrition0NN
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This research is particularly important in Sub Saharan Africa where the malaria hookworm association results in maternal anemia and subsequent growth restrictions in utero

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WordScorePoS
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Label: 8, with a score of: 0.369463167874021
WordScorePoS
research0NN
saharan0JJ
africa0IN
malaria0NN
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maternal0JJ
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Understanding the role of environmental factors during pregnancy also has important implications for helping reduce the million perinatal deaths that occur every year

Label: 3, with a score of: 0.706134805760405
WordScorePoS
environmental0JJ
help0NN
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Label: 12, with a score of: 0.51947139105423
WordScorePoS
environmental0.0598270388037045JJ
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More clinical trials are needed to test whether ALRIs are water washable using hand washing or more comprehensive household hygiene interventions Ahmed and others

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WordScorePoS
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Label: 12, with a score of: 0.325444917641174
WordScorePoS
water0.186896403054502NN
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Additionally clinical trials on indoor air pollution are also needed

Label: 14, with a score of: 0.605812469342387
WordScorePoS
additionally0RB
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Label: 12, with a score of: 0.497027388029788
WordScorePoS
additionally0RB
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Label: 11, with a score of: 0.434600238273636
WordScorePoS
additionally0RB
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Studies using deaths as end points would be important when health effects of both WSH and indoor air pollution are established to overcome current methodological issues that lead to underestimating effects of these factors

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WordScorePoS
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WordScorePoS
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Recognizing the links between infections and malnutrition future studies should properly account for correlated multiple risk factors

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WordScorePoS
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Label: 1, with a score of: 0.372343901019344
WordScorePoS
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Label: 11, with a score of: 0.355780539922791
WordScorePoS
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Current studies on the effect of malnutrition on respiratory infections for example Fishman and others do not control for indoor air pollution exposure

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WordScorePoS
current0JJ
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Label: 3, with a score of: 0.453605137993913
WordScorePoS
current0JJ
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Label: 14, with a score of: 0.321700629019157
WordScorePoS
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Similarly studies on the effect of indoor air pollution or poor water and sanitation rarely control for malnutrition

Label: 6, with a score of: 0.89422014034865
WordScorePoS
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Label: 12, with a score of: 0.253766537476269
WordScorePoS
study0NN
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Label: 1, with a score of: 0.241902183508842
WordScorePoS
study0NN
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In the absence of such controls the burden from specific disease for example diarrheal infections attributable to various risk factors such as WSH or malnutrition may exceed percent

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WordScorePoS
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Label: 6, with a score of: 0.366315277009239
WordScorePoS
control0NN
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Label: 1, with a score of: 0.348282928029589
WordScorePoS
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HOW LARGE IS THE ENVIRONMENTAL HEALTH BURDEN

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WordScorePoS
environmental0JJ
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Label: 12, with a score of: 0.357899080308486
WordScorePoS
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Key Messages â–  â–  â–  â–  In terms of child health the environmental health burden is substantially higher than previously estimated if links through malnutrition are incorporated especially in those subregions such as Sub Saharan Africa and South Asia where both malnutrition and poor environmental conditions coexist

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WordScorePoS
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Label: 1, with a score of: 0.469106618658868
WordScorePoS
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Label: 17, with a score of: 0.199322104092212
WordScorePoS
key0NN
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In Sub Saharan Africa environmental health conditions which cause poorer fetus and child survival may explain the counterintuitively lower malnutrition rates when compared with South Asia from poorer fetus and child survival

Label: 3, with a score of: 0.651555353034023
WordScorePoS
saharan0.0299516555085695JJ
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Label: 1, with a score of: 0.40458737538099
WordScorePoS
saharan0.0442083771593746JJ
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Even when the environmental health burden is conservatively estimated multiplier effect exists for environmental health interventions where investments addressing environmental risks for example lack of water and sanitation not only reduce diarrhea mortality but also reduce mortality from malnutritionrelated diseases and its consequences on educational attainment

Label: 3, with a score of: 0.688586216408861
WordScorePoS
environmental0JJ
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Label: 6, with a score of: 0.534812878854227
WordScorePoS
environmental0JJ
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Label: 12, with a score of: 0.258054301620649
WordScorePoS
environmental0.0598270388037045JJ
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Future research is needed on environmental health effects during pregnancy additional disease transmission pathways and better relative risk estimates to more accurately estimate the environmental health burden in children under five years of age

Label: 3, with a score of: 0.786934859545277
WordScorePoS
future0NN
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Notes The authors definition was fairly broad and covered conditions including war violence and alcohol

Label: 16, with a score of: 0.599832955007344
WordScorePoS
definition0NN
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violence0.164686343640793NN
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Label: 8, with a score of: 0.442812254382393
WordScorePoS
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Label: 1, with a score of: 0.43804279972199
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definition0.120266261535276NN
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For more details on Comparative Risk Assessment project publications see http www

Label: 3, with a score of: 0.496870185208907
WordScorePoS
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project0NN

Label: 12, with a score of: 0.468917277261451
WordScorePoS
risk0NN
project0.0664302389559493NN

Label: 11, with a score of: 0.445994361407495
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int healthinfo boddocscra en index

Label: 0, with a score of: 1

Fishman and others cite recent meta analysis that shows diarrheal incidence is percent higher to percent with percent confidence interval in children with moderate to severe malnutrition

Label: 0, with a score of: 1

The distinction between direct and indirect effects of environmental risk factors is conceptual

Label: 11, with a score of: 0.662497417058472
WordScorePoS
direct0.04477822029736JJ
effect0NN
environmental0.0537696560159885JJ
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Label: 1, with a score of: 0.393884108931497
WordScorePoS
direct0JJ
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environmental0.0442083771593746JJ
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In practice when calculating the burden of disease related to these risk factors the two effects may be difficult to separate

Label: 3, with a score of: 0.744513207574839
WordScorePoS
practice0NN
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disease0.215415047323213NN
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Label: 6, with a score of: 0.388637131322086
WordScorePoS
practice0NN
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Label: 2, with a score of: 0.368110024545515
WordScorePoS
practice0.0252000451111224NN
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According to recent meta analysis of studies by van Geertruyden and others malaria deaths globally are underestimated by million deaths

Label: 3, with a score of: 0.970800869222003
WordScorePoS
study0NN
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This is an alternative complementary explanation to the Mills Reincke phenomenon Cairncross in addition to those provided in box

Label: 9, with a score of: 0.897334267285876
WordScorePoS
alternative0.0602029956716497NN
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All together about deaths annually are associated with indoor air pollution Smith Mehta and Maeusezahl Feuz

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WordScorePoS
death0.193573191943949NN
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Label: 11, with a score of: 0.335107029169558
WordScorePoS
death0.0315914058171786NN
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Label: 14, with a score of: 0.320337394031366
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death0NN
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H P E Estimating the Environmental Health Burden and Costs at the Country Level IN PART new results from the World Health Organization WHO on the environmental health burden of disease were presented and findings were discussed Fewtrell and others

Label: 3, with a score of: 0.817806354202317
WordScorePoS
estimate0.059903311017139NN
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These new calculations take into account the effects of environmental risk factors including their effects on malnutrition

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Label: 2, with a score of: 0.4422918505005
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Label: 11, with a score of: 0.404770832892153
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Label: 12, with a score of: 0.348839647225465
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account0.0577345906651901NN
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In this part the analysis is taken to the next stage estimating and translating this burden into economic costs at country level

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Label: 10, with a score of: 0.481884271660802
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Label: 16, with a score of: 0.329951929304887
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Label: 9, with a score of: 0.325411779660774
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Label: 1, with a score of: 0.305524884528749
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stage0NN
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With the use of case studies from Ghana and Pakistan earlier estimates are updated by calculating the effects of environmental risks including the impacts through malnutrition and by attempting to estimate the impacts on cognition and learning and on future work productivity and income see appendix for detailed methodology

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Label: 10, with a score of: 0.242158604857424
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Label: 2, with a score of: 0.329283818976518
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Existing Practice in Environmental Health Valuation The World Bank has made extensive use of valuation techniques to measure the costs of environmental degradation at the country level

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Label: 12, with a score of: 0.559815304586183
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Studies of the cost of environmental health effects are mostly based on quantification and valuation of disease specific mortality and morbidity caused by environmental risk factors

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In developing countries these studies have focused mainly on environmental risks such as inadequate supply of water sanitation and hygiene WSH indoor air pollution from household solid fuels urban outdoor air pollution and sometimes exposure to lead

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Label: 12, with a score of: 0.353086073617912
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To value health risks these analyses have typically ENVIRONMENTAL HEALTH AND CHILD SURVIVAL looked at different health end points such as deaths or years of life lost years lived with disability incidence of diarrheal and respiratory illness number of hospital admissions number of doctor visits restricted activity days number of days of caregiver and so on

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live0.0300513417930436VB
disability0NN
incidence0.0407408489778079NN
illness0.0407408489778079NN
activity0NN
day0.0175975629039954NN

Label: 1, with a score of: 0.494422716245956
WordScorePoS
health0NN
risk0.0519476926891779NN
typically0RB
environmental0.0442083771593746JJ
child0.0450489732120807NN
death0NN
life0.0184786920895884NN
lose0VB
live0.0739258553811849VB
disability0NN
incidence0NN
illness0NN
activity0NN
day0.25973846344589NN

In general child mortality has been valued using the human capital approach that is the present value of the average individual income stream and adult mortality has been valued using both the human capital approach and the value of statistical life reflecting individuals willingness to pay for reduction in the risk of death

Label: 3, with a score of: 0.720570334968197
WordScorePoS
child0.10682408961305NN
mortality0.276962203701274NN
value0NN
human0JJ
approach0NN
average0NN
individual0JJ
income0NN
adult0JJ
statistical0JJ
life0.0250390290383647NN
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pay0NN
reduction0.0149758277542848NN
risk0.0703902516159815NN
death0.193573191943949NN

Label: 10, with a score of: 0.4779996157153
WordScorePoS
child0.0242343960710022NN
mortality0.0488696285210061NN
value0NN
human0JJ
approach0NN
average0.146608885563018NN
individual0.064698038783335JJ
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adult0JJ
statistical0JJ
life0NN
reflect0VB
pay0.02794560829783NN
reduction0.0475643836183697NN
risk0NN
death0NN

Label: 4, with a score of: 0.210925061043285
WordScorePoS
child0.076326555629389NN
mortality0NN
value0NN
human0.0152653111258778JJ
approach0NN
average0NN
individual0JJ
income0NN
adult0.163013873070017JJ
statistical0JJ
life0.0125233923809486NN
reflect0VB
pay0NN
reduction0NN
risk0NN
death0NN

Label: 13, with a score of: 0.190794096811641
WordScorePoS
child0NN
mortality0NN
value0NN
human0.0205355488872215JJ
approach0NN
average0.1656430212089NN
individual0JJ
income0NN
adult0JJ
statistical0JJ
life0.00842350130803634NN
reflect0VB
pay0NN
reduction0.0403047273067529NN
risk0NN
death0NN

Morbidity has been valued by the cost of illness including the cost of hospital admissions doctor visits restricted activity days time and income losses from illness and days of caregiving

Label: 1, with a score of: 0.720738949327473
WordScorePoS
value0NN
cost0NN
illness0NN
include0VB
activity0NN
day0.25973846344589NN
time0NN
income0.0442083771593746NN
loss0NN

Label: 10, with a score of: 0.459569603369994
WordScorePoS
value0NN
cost0.0660824365173543NN
illness0NN
include0VB
activity0NN
day0NN
time0.0607862199751165NN
income0.166475342664294NN
loss0NN

A fraction of the average wage is usually taken as the unit value of time lost to illness and caregiver time see appendix for more details

Label: 10, with a score of: 0.81938095907529
WordScorePoS
average0.146608885563018NN
wage0.064698038783335NN
time0.0607862199751165NN
lose0VB
illness0NN

Label: 13, with a score of: 0.40772950245528
WordScorePoS
average0.1656430212089NN
wage0NN
time0NN
lose0VB
illness0NN

The cost of environmental health risks at the country level has ranged from

Label: 3, with a score of: 0.65456290896198
WordScorePoS
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
country0NN
level0NN
range0.0249430985430622NN

Label: 11, with a score of: 0.335094893633507
WordScorePoS
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
country0NN
level0.00692515656684925NN
range0NN

percent of gross domestic product GDP in Tunisia to more than

Label: 8, with a score of: 0.638993159606952
WordScorePoS
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN
gdp0NN

Label: 9, with a score of: 0.478019190968555
WordScorePoS
gross0.030745604615229JJ
domestic0.0520080474473126JJ
product0.0442597400933733NN
gdp0NN

Label: 17, with a score of: 0.400385523201633
WordScorePoS
gross0.0249900578719309JJ
domestic0.0634082886861185JJ
product0.017987180284335NN
gdp0NN

Label: 11, with a score of: 0.360652009715876
WordScorePoS
gross0.0373517915079663JJ
domestic0.0315914058171786JJ
product0.0268848280079943NN
gdp0NN

percent of GDP in China see figure

Label: 9, with a score of: 0.749355860981293
WordScorePoS
gdp0NN
figure0.0602029956716497NN

Label: 14, with a score of: 0.662167496644908
WordScorePoS
gdp0.0531983120572613NN
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These costs have typically represented between and percent of total cost of environmental degradation environmental health and natural resources

Label: 15, with a score of: 0.369523948090656
WordScorePoS
cost0NN
typically0RB
represent0VB
total0NN
environmental0JJ
degradation0.221714625071441NN
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natural0.016202004209163JJ
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Label: 3, with a score of: 0.262214365289656
WordScorePoS
cost0NN
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Label: 12, with a score of: 0.6140797103014
WordScorePoS
cost0.0277064208763707NN
typically0RB
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total0.0468670845659596NN
environmental0.0598270388037045JJ
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natural0.0509717462875914JJ
resource0.0416785799329393NN

Label: 10, with a score of: 0.301762318464013
WordScorePoS
cost0.0660824365173543NN
typically0RB
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total0NN
environmental0.0237821918091848JJ
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natural0JJ
resource0NN

Lack of access to water supply and sanitation and poor hygiene often take the largest share of environmental health risks

Label: 6, with a score of: 0.829360873802272
WordScorePoS
lack0.0214003646985842NN
access0.00731085509381114NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
poor0.0642010940957526JJ
hygiene0.136665345449673NN
largest0JJS
share0NN
environmental0JJ
health0NN
risk0NN

Label: 12, with a score of: 0.272286870750855
WordScorePoS
lack0NN
access0.00232174891244877NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
poor0.0339811641917276JJ
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environmental0.0598270388037045JJ
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risk0NN

Label: 3, with a score of: 0.232771899794547
WordScorePoS
lack0NN
access0.00610236075888593NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
poor0JJ
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environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN

Label: 1, with a score of: 0.230094241593281
WordScorePoS
lack0.0753297582301286NN
access0.00514687440545096NN
water0NN
supply0NN
sanitation0NN
poor0.150659516460257JJ
hygiene0NN
largest0JJS
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environmental0.0442083771593746JJ
health0NN
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In Bolivia El Salvador Guatemala and Nigeria indoor air pollution is particularly important

Label: 14, with a score of: 0.605812469342387
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN

Results from these valuation studies often quoted in various newspapers have been used to raise awareness on environmental issues in many countries as well as to attempt to catch the attention of policy makers

Label: 12, with a score of: 0.546564853031867
WordScorePoS
result0NN
study0NN
raise0.0332151194779746NN
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Label: 10, with a score of: 0.455852532595785
WordScorePoS
result0NN
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environmental0.0237821918091848JJ
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Label: 11, with a score of: 0.363196763713095
WordScorePoS
result0NN
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environmental0.0537696560159885JJ
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Label: 13, with a score of: 0.352439384715823
WordScorePoS
result0NN
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environmental0JJ
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In Algeria for example the results were used at the highest political level and proved instrumental in increasing the budget for environmental protection by US million

Label: 5, with a score of: 0.50034496856272
WordScorePoS
result0NN
political0.111637082206855JJ
level0.0172651853471334NN
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protection0.0465610847355851NN

Label: 1, with a score of: 0.497402685124214
WordScorePoS
result0NN
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environmental0.0442083771593746JJ
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Label: 10, with a score of: 0.479307041313351
WordScorePoS
result0NN
political0.0792212041430275JJ
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increase0.00285817158600878NN
environmental0.0237821918091848JJ
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The studies have also sparked interest in additional work

Label: 15, with a score of: 0.668742724218604
WordScorePoS
study0.0517339898971162NN
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Label: 2, with a score of: 0.56965233863445
WordScorePoS
study0NN
additional0.0440683498519077JJ

Label: 17, with a score of: 0.477785916381995
WordScorePoS
study0NN
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For example the governments of Algeria the Arab Republic of Egypt and Morocco have commissioned in depth analyses of the costs of environmental degradation in the water sector

Label: 6, with a score of: 0.737952068572042
WordScorePoS
government0NN
commission0NN
cost0NN
environmental0JJ
degradation0NN
water0.556409482163189NN
sector0.0214003646985842NN

Label: 12, with a score of: 0.499451194946082
WordScorePoS
government0NN
commission0NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
degradation0.0996453584339239NN
water0.186896403054502NN
sector0.0169905820958638NN

Label: 15, with a score of: 0.303856138276076
WordScorePoS
government0NN
commission0NN
cost0NN
environmental0JJ
degradation0.221714625071441NN
water0.016202004209163NN
sector0NN

Tunisia is in the process of setting up unit of environmental economics and policy in the Ministry of Environment to build capacity to undertake such analyses

Label: 17, with a score of: 0.530574084951137
WordScorePoS
process0NN
set0.0978661089756501NN
environmental0JJ
economics0NNS
policy0.0641521854453136NN
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build0.0499801157438617VB
capacity0.0451108483130998NN
undertake0VB

Label: 12, with a score of: 0.347210527450801
WordScorePoS
process0NN
set0NN
environmental0.0598270388037045JJ
economics0NNS
policy0.0203215381458133NN
environment0.079769385071606NN
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capacity0.00833571598658786NN
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Label: 9, with a score of: 0.330173596169222
WordScorePoS
process0.0737171311497939NN
set0NN
environmental0.0221298700466866JJ
economics0NNS
policy0.011275328195446NN
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build0.030745604615229VB
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Label: 5, with a score of: 0.327774853974243
WordScorePoS
process0.0558185411034276NN
set0NN
environmental0JJ
economics0NNS
policy0.0341506708422088NN
environment0NN
build0VB
capacity0NN
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Label: 1, with a score of: 0.310939473158474
WordScorePoS
process0NN
set0NN
environmental0.0442083771593746JJ
economics0NNS
policy0.0450489732120807NN
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build0.0614198493690006VB
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Label: 8, with a score of: 0.301965380686823
WordScorePoS
process0NN
set0NN
environmental0.0295821503613099JJ
economics0NNS
policy0.0452169560888236NN
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Building New Estimates for Environmental Health Costs Research evidence discussed in chapter highlights the importance of the vicious cycle of malnutrition and infections

Label: 3, with a score of: 0.599225213403403
WordScorePoS
building0NN
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
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research0.0175975629039954NN
evidence0NN
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malnutrition0NN
infection0.122222546933424NN

Label: 10, with a score of: 0.398018905253365
WordScorePoS
building0NN
estimate0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
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evidence0.12939607756667NN
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Label: 17, with a score of: 0.229725067778849
WordScorePoS
building0.149940347231585NN
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environmental0JJ
health0NN
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evidence0NN
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malnutrition0NN
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Label: 12, with a score of: 0.382967539038049
WordScorePoS
building0NN
estimate0.0199423462679015NN
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health0.0339811641917276NN
cost0.0277064208763707NN
research0NN
evidence0NN
cycle0.108503934593034NN
malnutrition0NN
infection0NN

This new valuation exercise seeks to estimate previously unaccounted costs associated with how environmental risk factors affect mortality through their effects on malnutrition

Label: 3, with a score of: 0.685760370742482
WordScorePoS
seek0VB
estimate0.059903311017139NN
cost0NN
environmental0JJ
risk0.0703902516159815NN
affect0.00625975725959118VB
mortality0.276962203701274NN
effect0NN
malnutrition0NN

Label: 1, with a score of: 0.511660198216407
WordScorePoS
seek0.120266261535276VB
estimate0NN
cost0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
affect0.0184786920895884VB
mortality0NN
effect0NN
malnutrition0.0736315832425121NN

In the short term this calculation means including portion of the deaths not usually attributed to environmental factors for example measles that would not have occurred if the child had not been malnourished

Label: 3, with a score of: 0.710692573050574
WordScorePoS
term0NN
means0NNS
include0VB
death0.193573191943949NN
environmental0JJ
measles0.0407408489778079NNS
occur0.0307735781890304VB
child0.10682408961305NN

Label: 17, with a score of: 0.286242808098226
WordScorePoS
term0.149793392961411NN
means0NNS
include0VB
death0NN
environmental0JJ
measles0NNS
occur0VB
child0NN

Label: 1, with a score of: 0.40038232561109
WordScorePoS
term0NN
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include0VB
death0NN
environmental0.0442083771593746JJ
measles0NNS
occur0VB
child0.0450489732120807NN

In the longer term it means assessing the impact and subsequent costs associated with impaired cognition and learning caused by malnutrition which in turn was affected by environmental factors

Label: 4, with a score of: 0.486016445394892
WordScorePoS
term0NN
means0NNS
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affect0.0125233923809486VB
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Label: 17, with a score of: 0.283227755492099
WordScorePoS
term0.149793392961411NN
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impact0NN
cost0NN
learn0VB
cause0NN
malnutrition0NN
affect0VB
environmental0JJ

Label: 1, with a score of: 0.485148028602646
WordScorePoS
term0NN
means0.120266261535276NNS
impact0NN
cost0NN
learn0VB
cause0NN
malnutrition0.0736315832425121NN
affect0.0184786920895884VB
environmental0.0442083771593746JJ

Label: 12, with a score of: 0.36077542739622
WordScorePoS
term0NN
means0NNS
impact0.0866018859977851NN
cost0.0277064208763707NN
learn0VB
cause0NN
malnutrition0NN
affect0.0166714319731757VB
environmental0.0598270388037045JJ

ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL FIGURE

Label: 3, with a score of: 0.613542533645484
WordScorePoS
estimate0.059903311017139NN
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health0.191387734041787NN
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country0NN
level0NN
figure0NN

Label: 12, with a score of: 0.357917872326057
WordScorePoS
estimate0.0199423462679015NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
cost0.0277064208763707NN
country0NN
level0.00513687014008325NN
figure0NN

Label: 9, with a score of: 0.347120152309878
WordScorePoS
estimate0.0221298700466866NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
burden0NN
cost0NN
country0NN
level0NN
figure0.0602029956716497NN

Label: 10, with a score of: 0.31835220924536
WordScorePoS
estimate0NN
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health0.0405241466500776NN
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cost0.0660824365173543NN
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level0NN
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Cost of Environmental Health Risks Tunisia Lebanon Colombia Peru Guatemala Egypt Arab Rep

Label: 3, with a score of: 0.694620156289698
WordScorePoS
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN

Label: 11, with a score of: 0.371108916845941
WordScorePoS
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN

Label: 10, with a score of: 0.345982764842136
WordScorePoS
cost0.0660824365173543NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN

Label: 12, with a score of: 0.322435466883235
WordScorePoS
cost0.0277064208763707NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN

of Nigeria Iran Islamic Rep

Label: 0, with a score of: 1

of Ghana Pakistan China

Label: 0, with a score of: 1

percent urban air pollution indoor air pollution water sanitation and hygiene Source China World Bank Colombia Ghana Guatemala Nigeria Pakistan and Peru Country Environmental Analysis Arab Republic of Egypt World Bank Islamic Republic of Iran World Bank Lebanon and Tunisia Sarraf Larsen and Owaygen

Label: 6, with a score of: 0.823411157315705
WordScorePoS
urban0JJ
air0NN
pollution0.0590310971343993NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN
country0NN
environmental0JJ

Label: 11, with a score of: 0.359280464661204
WordScorePoS
urban0.27622591898666JJ
air0.0373517915079663NN
pollution0.0315914058171786NN
water0.0458109463416786NN
sanitation0NN
hygiene0NN
source0NN
world0.00626002771693937NN
bank0NN
country0NN
environmental0.0537696560159885JJ

Label: 12, with a score of: 0.28227496648622
WordScorePoS
urban0JJ
air0.0554128417527413NN
pollution0.0234335422829798NN
water0.186896403054502NN
sanitation0NN
hygiene0NN
source0NN
world0.00464349782489754NN
bank0NN
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environmental0.0598270388037045JJ

Notes Economic burden includes the burden from mortality morbidity and cost of illness

Label: 3, with a score of: 0.702744530867062
WordScorePoS
economic0JJ
burden0NN
include0VB
mortality0.276962203701274NN
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illness0.0407408489778079NN

Label: 8, with a score of: 0.284156061074602
WordScorePoS
economic0.128463821595706JJ
burden0NN
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mortality0NN
cost0NN
illness0NN

Label: 10, with a score of: 0.482712312035243
WordScorePoS
economic0.103276847978089JJ
burden0NN
include0VB
mortality0.0488696285210061NN
cost0.0660824365173543NN
illness0NN

Morbidity is usually valued using the human capital value approach

Label: 12, with a score of: 0.599499919415824
WordScorePoS
value0NN
human0.0101607690729067JJ
approach0.0542519672965169NN

Label: 15, with a score of: 0.544055900435445
WordScorePoS
value0.0390772412228479NN
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Adult mortality is valued by averaging the value of statistical life approach and the human capital value approach

Label: 3, with a score of: 0.615038629361336
WordScorePoS
adult0JJ
mortality0.276962203701274NN
value0NN
average0NN
statistical0JJ
life0.0250390290383647NN
approach0NN
human0JJ

Label: 10, with a score of: 0.398100485488677
WordScorePoS
adult0JJ
mortality0.0488696285210061NN
value0NN
average0.146608885563018NN
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life0NN
approach0NN
human0JJ

Label: 13, with a score of: 0.396315571898593
WordScorePoS
adult0JJ
mortality0NN
value0NN
average0.1656430212089NN
statistical0JJ
life0.00842350130803634NN
approach0NN
human0.0205355488872215JJ

Label: 4, with a score of: 0.388577735633296
WordScorePoS
adult0.163013873070017JJ
mortality0NN
value0NN
average0NN
statistical0JJ
life0.0125233923809486NN
approach0NN
human0.0152653111258778JJ

With the exception of China the Islamic Republic of Iran and Nigeria child mortality is valued using human capital value only

Label: 3, with a score of: 0.892775626912015
WordScorePoS
child0.10682408961305NN
mortality0.276962203701274NN
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human0JJ

With the exception of China the value of statistical life is obtained through benefit transfer of international studies

Label: 14, with a score of: 0.511886045852646
WordScorePoS
statistical0JJ
life0.0081738237776987NN
obtain0VB
benefit0.0229784274580034NN
transfer0.0803666323453555NN
international0.00470029406779661JJ
study0NN

Label: 15, with a score of: 0.469783372798951
WordScorePoS
statistical0JJ
life0.00794883334420673NN
obtain0VB
benefit0.0446918591208085NN
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international0.00228545753063677JJ
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Label: 4, with a score of: 0.430014931980313
WordScorePoS
statistical0JJ
life0.0125233923809486NN
obtain0.0815069365350084VB
benefit0NN
transfer0NN
international0.00360073990568919JJ
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Label: 17, with a score of: 0.406885653401935
WordScorePoS
statistical0.048933054487825JJ
life0NN
obtain0VB
benefit0NN
transfer0.036961556179878NN
international0.00648516099948979JJ
study0NN

Water sanitation and hygiene mortality is estimated only for children in China such mortality excludes lack of sanitation and hygiene costs

Label: 6, with a score of: 0.854537688516016
WordScorePoS
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
mortality0NN
estimate0NN
child0.0255958462813622NN
lack0.0214003646985842NN
cost0NN

Label: 3, with a score of: 0.447033706542284
WordScorePoS
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
mortality0.276962203701274NN
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child0.10682408961305NN
lack0NN
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Label: 12, with a score of: 0.129633507337633
WordScorePoS
water0.186896403054502NN
sanitation0NN
hygiene0NN
mortality0NN
estimate0.0199423462679015NN
child0NN
lack0NN
cost0.0277064208763707NN

Estimating and Valuing Health Impacts Accounting for Malnutrition Repeated infections in early childhood contribute to malnutrition

Label: 3, with a score of: 0.681941691607198
WordScorePoS
estimate0.059903311017139NN
value0NN
health0.191387734041787NN
impact0NN
accounting0NN
malnutrition0NN
infection0.122222546933424NN
childhood0NN
contribute0VB

Label: 12, with a score of: 0.357733845515063
WordScorePoS
estimate0.0199423462679015NN
value0NN
health0.0339811641917276NN
impact0.0866018859977851NN
accounting0NN
malnutrition0NN
infection0NN
childhood0NN
contribute0.0554128417527413VB

Malnutrition in turn makes children more vulnerable to repeated infections

Label: 1, with a score of: 0.587189312013204
WordScorePoS
malnutrition0.0736315832425121NN
child0.0450489732120807NN
vulnerable0.112994637345193JJ
infection0NN

Label: 3, with a score of: 0.580527136836637
WordScorePoS
malnutrition0NN
child0.10682408961305NN
vulnerable0JJ
infection0.122222546933424NN

Label: 4, with a score of: 0.322847003230836
WordScorePoS
malnutrition0NN
child0.076326555629389NN
vulnerable0.051052537468787JJ
infection0NN

As discussed in chapter numerous studies have found that infections especially diarrheal disease in the first few years of children life impair weight gains often in the range of to percent Adair and others Bairagi and others Black Brown and Becker Checkley and others Condon Paoloni and others Molbak and others Rowland Cole and Whitehead Rowland Rowland and Cole Zumrawi Dimond and Waterlow

Label: 3, with a score of: 0.874807578408073
WordScorePoS
study0NN
infection0.122222546933424NN
disease0.215415047323213NN
child0.10682408961305NN
life0.0250390290383647NN
gain0NN
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Valuing Education and Cognition Costs Children exposed to poor environmental conditions often end up malnourished which in turn impairs their cognitive development and educational performance

Label: 4, with a score of: 0.515772264447518
WordScorePoS
value0NN
education0.244244978014045NN
cost0NN
child0.076326555629389NN
poor0JJ
environmental0JJ
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development0.0279277626235394NN
educational0JJ
performance0NN

Label: 1, with a score of: 0.412803197634234
WordScorePoS
value0NN
education0.0225244866060403NN
cost0NN
child0.0450489732120807NN
poor0.150659516460257JJ
environmental0.0442083771593746JJ
condition0NN
development0.0164833460638534NN
educational0JJ
performance0NN

Label: 8, with a score of: 0.321099733020614
WordScorePoS
value0NN
education0.0150723186962745NN
cost0NN
child0.0452169560888236NN
poor0JJ
environmental0.0295821503613099JJ
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development0.0055149369084567NN
educational0JJ
performance0NN

Label: 10, with a score of: 0.308796384171349
WordScorePoS
value0NN
education0.0121171980355011NN
cost0.0660824365173543NN
child0.0242343960710022NN
poor0JJ
environmental0.0237821918091848JJ
condition0NN
development0.0177346522508396NN
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performance0.064698038783335NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL This impairment affects labor productivity thus reducing individual earnings

Label: 3, with a score of: 0.596392674211593
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
affect0.00625975725959118VB
productivity0NN
reduce0.01675146888405VB
individual0JJ

Label: 10, with a score of: 0.342129592107439
WordScorePoS
environmental0.0237821918091848JJ
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child0.0242343960710022NN
affect0VB
productivity0NN
reduce0.0310356414389692VB
individual0.064698038783335JJ

Label: 11, with a score of: 0.320656662260945
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
child0.0273960270556257NN
affect0.0112376090361851VB
productivity0.0373517915079663NN
reduce0.0200483235258943VB
individual0JJ

Furthermore malnutrition can lead to delayed primary school enrollment and grade repetition which in turn may affect lifetime income in terms of delayed labor force entry

Label: 4, with a score of: 0.569418697302388
WordScorePoS
malnutrition0NN
lead0.0255262687343935NN
primary0.108423939529757JJ
school0.208127520578185NN
affect0.0125233923809486VB
income0NN
term0NN
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Label: 10, with a score of: 0.330932936080321
WordScorePoS
malnutrition0NN
lead0NN
primary0JJ
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affect0VB
income0.166475342664294NN
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force0NN

Label: 17, with a score of: 0.269422147117472
WordScorePoS
malnutrition0NN
lead0NN
primary0JJ
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affect0VB
income0.017987180284335NN
term0.149793392961411NN
force0NN

Label: 5, with a score of: 0.380104502228005
WordScorePoS
malnutrition0NN
lead0NN
primary0.0970239057629001JJ
school0.0931221694711702NN
affect0VB
income0NN
term0NN
force0.0465610847355851NN

As discussed in chapter number of recent longitudinal studies see appendix have investigated the effect of early childhood malnutrition on educational outcomes

Label: 4, with a score of: 0.546140573569532
WordScorePoS
study0NN
effect0NN
childhood0.0815069365350084NN
malnutrition0NN
educational0JJ
outcome0.0416255041156371NN

Label: 6, with a score of: 0.4886405820301
WordScorePoS
study0NN
effect0NN
childhood0NN
malnutrition0.041835863322702NN
educational0.0683326727248364JJ
outcome0NN

These studies use data that follow children over time usually from birth to well into primary or secondary school level and they contain various anthropometric schooling and socioeconomic status indicators

Label: 4, with a score of: 0.653432840938577
WordScorePoS
study0NN
datum0NN
child0.076326555629389NN
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birth0NN
primary0.108423939529757JJ
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level0.0231525547935232NN
schooling0NN
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Label: 5, with a score of: 0.401356018308446
WordScorePoS
study0NN
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child0.0170753354211044NN
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primary0.0970239057629001JJ
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Label: 16, with a score of: 0.37045273015585
WordScorePoS
study0NN
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child0.0603953832457135NN
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Label: 3, with a score of: 0.336559102901559
WordScorePoS
study0NN
datum0NN
child0.10682408961305NN
time0.0127591822694525NN
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school0NN
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schooling0.0407408489778079NN
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The studies analyzed show that the change in grade attainment ranges from

Label: 13, with a score of: 0.93113602896661
WordScorePoS
study0NN
change0.402565546215053NN
range0.0335649154577099NN

years mild stunting in the Philippines to

Label: 2, with a score of: 1
WordScorePoS
stunt0.11668334276823NN

years moderate malnutrition in Brazil and

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

Label: 6, with a score of: 0.455176256376397
WordScorePoS
malnutrition0.041835863322702NN

Label: 2, with a score of: 0.388624394633276
WordScorePoS
malnutrition0.0357189919948307NN

years in Zimbabwe for each score one standard deviation from the mean

Label: 9, with a score of: 0.742868974909555
WordScorePoS
standard0.0454743001434393NN

Label: 12, with a score of: 0.66943684251528
WordScorePoS
standard0.0409791940864438NN

The effect of malnutrition on learning productivity or achievement appears to be even larger ranging from

Label: 4, with a score of: 0.62495475082852
WordScorePoS
effect0NN
malnutrition0NN
learn0.244520809605025VB
productivity0NN
achievement0NN
range0NN

Label: 9, with a score of: 0.540375628856866
WordScorePoS
effect0.0454743001434393NN
malnutrition0NN
learn0VB
productivity0.0922368138456871NN
achievement0.0368585655748969NN
range0.0368585655748969NN

Label: 1, with a score of: 0.376380299351732
WordScorePoS
effect0NN
malnutrition0.0736315832425121NN
learn0VB
productivity0NN
achievement0.0736315832425121NN
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Label: 2, with a score of: 0.356225580484266
WordScorePoS
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
learn0VB
productivity0.0595900566394012NN
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years of grade equivalent in Guatemala and the Philippines for each score to

Label: 12, with a score of: 0.73736624946011
WordScorePoS
equivalent0.0664302389559493JJ

years for each score in severely malnourished children

Label: 3, with a score of: 0.614417683772385
WordScorePoS
severely0RB
child0.10682408961305NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
severely0RB
child0.076326555629389NN

Label: 16, with a score of: 0.347374750571648
WordScorePoS
severely0RB
child0.0603953832457135NN

Label: 2, with a score of: 0.314234936000714
WordScorePoS
severely0RB
child0.0546336178945768NN

Delayed primary school entry may vary between two and four months per score in the studies reviewed

Label: 4, with a score of: 0.743753953062679
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
study0NN
review0NN

Label: 5, with a score of: 0.608562659441768
WordScorePoS
primary0.0970239057629001JJ
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Case Studies of Ghana and Pakistan The previous subsections mention the progress in the methodology for estimating costs associated with environmental health risks that is extending the analysis to incorporate the malnutrition mediated effects of WSH related infections as well as estimating the longer term costs of lower school performance and work productivity from impaired cognitive development and learning capacity

Label: 3, with a score of: 0.496840955445745
WordScorePoS
study0NN
previous0JJ
progress0.0449274832628543NN
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risk0.0703902516159815NN
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related0.0125195145191824JJ
infection0.122222546933424NN
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development0.00837573444202498NN
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capacity0.00625975725959118NN

Label: 4, with a score of: 0.492155647511947
WordScorePoS
study0NN
previous0JJ
progress0.0299609328954485NN
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Label: 17, with a score of: 0.224171511562105
WordScorePoS
study0NN
previous0JJ
progress0.017987180284335NN
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term0.149793392961411NN
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development0.0469463607292177NN
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capacity0.0451108483130998NN

In this section this adapted methodology is applied to two country case studies Ghana and Pakistan

Label: 0, with a score of: 1

These countries were chosen for two reasons because each belongs to one of the two subregions that have the highest environmental health burden of disease in children under five and because in each country the methodology estimating the effects of environmental factors had been applied earlier providing an opportunity to compare the old excluding malnutrition and new including malnutrition estimates

Label: 3, with a score of: 0.680810373581845
WordScorePoS
country0NN
belong0VB
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
child0.10682408961305NN
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opportunity0NN
compare0.0307735781890304VB
malnutrition0NN
include0VB

Label: 1, with a score of: 0.434771495604969
WordScorePoS
country0NN
belong0.120266261535276VB
environmental0.0442083771593746JJ
health0NN
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child0.0450489732120807NN
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provide0.0295703421524739VB
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malnutrition0.0736315832425121NN
include0VB

In Ghana see box

Label: 0, with a score of: 1

country of million people one in every nine children dies before reaching age five

Label: 3, with a score of: 0.594607477855333
WordScorePoS
country0NN
people0.00539943740774902NNS
child0.10682408961305NN
die0.0748292956291867VB
reach0NN
age0.0893142758861673NN

Label: 1, with a score of: 0.42005007075707
WordScorePoS
country0NN
people0.0371911007748996NNS
child0.0450489732120807NN
die0VB
reach0NN
age0.112994637345193NN

Label: 4, with a score of: 0.34199584165668
WordScorePoS
country0NN
people0.00720147981137839NNS
child0.076326555629389NN
die0VB
reach0.0499016491051341NN
age0.0255262687343935NN

Under five mortality in the rural areas is per live births as compared with for the urban areas

Label: 3, with a score of: 0.684525876144895
WordScorePoS
mortality0.276962203701274NN
rural0JJ
live0.0300513417930436VB
birth0.0748292956291867NN
compare0.0307735781890304VB
urban0JJ

Label: 11, with a score of: 0.56497186574283
WordScorePoS
mortality0NN
rural0.0373517915079663JJ
live0.0269743071558856VB
birth0NN
compare0VB
urban0.27622591898666JJ

Label: 2, with a score of: 0.270945728199599
WordScorePoS
mortality0NN
rural0.148975141598503JJ
live0.0143446978608332VB
birth0NN
compare0VB
urban0JJ

Label: 10, with a score of: 0.309067293788275
WordScorePoS
mortality0.0488696285210061NN
rural0.0330412182586772JJ
live0.0159075630937118VB
birth0.0396106020715138NN
compare0VB
urban0.0488696285210061JJ

The country has an inadequate supply of piped water in terms of both population coverage rates and quality of services

Label: 6, with a score of: 0.795024490627145
WordScorePoS
country0NN
inadequate0.0836717266454039JJ
supply0.0590310971343993NN
water0.556409482163189NN
term0NN
population0.0363595928905615NN
coverage0NN
rate0NN
quality0.0255958462813622NN
service0.0084006124696649NN

Label: 12, with a score of: 0.30853982905155
WordScorePoS
country0NN
inadequate0JJ
supply0.0703006268489394NN
water0.186896403054502NN
term0NN
population0.0144336476662975NN
coverage0NN
rate0NN
quality0.0203215381458133NN
service0.00666957305782837NN

Label: 17, with a score of: 0.164237417284986
WordScorePoS
country0NN
inadequate0JJ
supply0NN
water0NN
term0.149793392961411NN
population0NN
coverage0NN
rate0NN
quality0.00916459792075908NN
service0NN

On average access to improved sanitation is also very low at percent World Bank while in the largest cities about percent of the population has household latrines

Label: 11, with a score of: 0.685642796781743
WordScorePoS
average0NN
access0.00626002771693937NN
improve0.0273960270556257VB
sanitation0NN
world0.00626002771693937NN
bank0NN
largest0JJS
city0.607697021770652NN
population0.0194583992186006NN
household0NN
latrine0NN

Label: 6, with a score of: 0.516251397565344
WordScorePoS
average0NN
access0.00731085509381114NN
improve0.0511916925627245VB
sanitation0.334686906581616NN
world0.00438651305628668NN
bank0NN
largest0JJS
city0NN
population0.0363595928905615NN
household0NN
latrine0.0683326727248364NN

Label: 10, with a score of: 0.289834994069514
WordScorePoS
average0.146608885563018NN
access0.00138439773401932NN
improve0.0121171980355011VB
sanitation0NN
world0.00276879546803864NN
bank0NN
largest0JJS
city0NN
population0.0860640399817412NN
household0.0330412182586772NN
latrine0NN

Label: 13, with a score of: 0.184425435265296
WordScorePoS
average0.1656430212089NN
access0NN
improve0.0102677744436108VB
sanitation0NN
world0.00351929966767313NN
bank0NN
largest0JJS
city0NN
population0NN
household0NN
latrine0NN

Label: 2, with a score of: 0.314836742054488
WordScorePoS
average0NN
access0.00749031153171887NN
improve0.0218534471578307VB
sanitation0NN
world0.0124838525528648NN
bank0.0881366997038154NN
largest0.0714379839896614JJS
city0.0440683498519077NN
population0.0310434135749871NN
household0.0297950283197006NN
latrine0NN

About percent of households use solid fuels for cooking in Ghana Ghana Statistical Service

Label: 7, with a score of: 0.794667225601784
WordScorePoS
household0NN
fuel0.0749457204978913NN
cooking0.122412709674631NN
statistical0JJ
service0.0451471467893167NN

Label: 5, with a score of: 0.408945273572605
WordScorePoS
household0.0465610847355851NN
fuel0.0558185411034276NN
cooking0NN
statistical0JJ
service0.022416649027415NN

Label: 12, with a score of: 0.312280765368482
WordScorePoS
household0.0554128417527413NN
fuel0.0332151194779746NN
cooking0NN
statistical0JJ
service0.00666957305782837NN

Results from household surveys reveal that among children under five years of age percent ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL BOX

Label: 3, with a score of: 0.62236020872259
WordScorePoS
result0NN
household0NN
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child0.10682408961305NN
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Label: 10, with a score of: 0.379212089325266
WordScorePoS
result0NN
household0.0330412182586772NN
survey0.064698038783335NN
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level0NN

Basic Indicators for Ghana and Pakistan Ghana Population

Label: 10, with a score of: 0.481161979310661
WordScorePoS
basic0JJ
population0.0860640399817412NN

Label: 11, with a score of: 0.435147682317734
WordScorePoS
basic0.0583751976558017JJ
population0.0194583992186006NN

Label: 8, with a score of: 0.359104143158486
WordScorePoS
basic0.0214106369326177JJ
population0.0428212738652355NN

Label: 1, with a score of: 0.357770056297363
WordScorePoS
basic0.0639932865717261JJ
population0NN

million Children under five years of age

Label: 3, with a score of: 0.637519347266509
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.513697864187194
WordScorePoS
child0.0450489732120807NN
age0.112994637345193NN

Label: 4, with a score of: 0.331057852656104
WordScorePoS
child0.076326555629389NN
age0.0255262687343935NN

million GDP US

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

billion Prevalence of malnutrition in children under five percenta Percentage of population having access to an improved water source percent Percentage of population having access to improved sanitation percent Energy from biomass products and waste percentage of total

Label: 6, with a score of: 0.722655122007015
WordScorePoS
prevalence0NN
malnutrition0.041835863322702NN
child0.0255958462813622NN
percentage0NN
population0.0363595928905615NN
access0.00731085509381114NN
improve0.0511916925627245VB
water0.556409482163189NN
source0.0613562156822703NN
sanitation0.334686906581616NN
energy0.0153390539205676NN
product0NN
waste0NN
total0.0295155485671997NN

Label: 7, with a score of: 0.411756798233174
WordScorePoS
prevalence0NN
malnutrition0NN
child0NN
percentage0NN
population0NN
access0.0157161992303584NN
improve0.0229264916384433VB
water0NN
source0.0274787313211514NN
sanitation0NN
energy0.494617163780726NN
product0NN
waste0.0625160381065121NN
total0.0528748274225028NN

Label: 12, with a score of: 0.32243042006695
WordScorePoS
prevalence0NN
malnutrition0NN
child0NN
percentage0NN
population0.0144336476662975NN
access0.00232174891244877NN
improve0VB
water0.186896403054502NN
source0NN
sanitation0NN
energy0.133960988253756NN
product0.0199423462679015NN
waste0.138532104381853NN
total0.0468670845659596NN

percent Under five mortality per live births Acute respiratory infection prevalence in children under five percentb Diarrhea prevalence in children under five

Label: 3, with a score of: 0.894701008752773
WordScorePoS
mortality0.276962203701274NN
live0.0300513417930436VB
birth0.0748292956291867NN
infection0.122222546933424NN
prevalence0.0407408489778079NN
child0.10682408961305NN

percentb Malaria incidence per

Label: 3, with a score of: 1
WordScorePoS
malaria0.20370424488904NN
incidence0.0407408489778079NN

Pakistan Population

Label: 10, with a score of: 0.758011782639692
WordScorePoS
population0.0860640399817412NN

Label: 8, with a score of: 0.377149738083129
WordScorePoS
population0.0428212738652355NN

Label: 6, with a score of: 0.320238276391338
WordScorePoS
population0.0363595928905615NN

million Children under five years of age

Label: 3, with a score of: 0.637519347266509
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.513697864187194
WordScorePoS
child0.0450489732120807NN
age0.112994637345193NN

Label: 4, with a score of: 0.331057852656104
WordScorePoS
child0.076326555629389NN
age0.0255262687343935NN

million GDP US

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

billion Prevalence of malnutrition in children under five percenta Percentage of population having access to an improved water source percent Percentage of population having access to improved sanitation percent Energy from biomass products and waste percentage of total

Label: 6, with a score of: 0.722655122007015
WordScorePoS
prevalence0NN
malnutrition0.041835863322702NN
child0.0255958462813622NN
percentage0NN
population0.0363595928905615NN
access0.00731085509381114NN
improve0.0511916925627245VB
water0.556409482163189NN
source0.0613562156822703NN
sanitation0.334686906581616NN
energy0.0153390539205676NN
product0NN
waste0NN
total0.0295155485671997NN

Label: 7, with a score of: 0.411756798233174
WordScorePoS
prevalence0NN
malnutrition0NN
child0NN
percentage0NN
population0NN
access0.0157161992303584NN
improve0.0229264916384433VB
water0NN
source0.0274787313211514NN
sanitation0NN
energy0.494617163780726NN
product0NN
waste0.0625160381065121NN
total0.0528748274225028NN

Label: 12, with a score of: 0.32243042006695
WordScorePoS
prevalence0NN
malnutrition0NN
child0NN
percentage0NN
population0.0144336476662975NN
access0.00232174891244877NN
improve0VB
water0.186896403054502NN
source0NN
sanitation0NN
energy0.133960988253756NN
product0.0199423462679015NN
waste0.138532104381853NN
total0.0468670845659596NN

percent Under five mortality per live births Acute respiratory infection prevalence in children under five percentb Diarrhea prevalence in children under five percentb Malaria incidence per

Label: 3, with a score of: 0.934067709962446
WordScorePoS
mortality0.276962203701274NN
live0.0300513417930436VB
birth0.0748292956291867NN
infection0.122222546933424NN
prevalence0.0407408489778079NN
child0.10682408961305NN
malaria0.20370424488904NN
incidence0.0407408489778079NN

Sources Population figures for children under five are from UNICEF country data malaria incidence figures are from RBM other information is from World Bank

Label: 3, with a score of: 0.625386804753217
WordScorePoS
source0NN
population0NN
figure0NN
child0.10682408961305NN
country0NN
datum0NN
malaria0.20370424488904NN
incidence0.0407408489778079NN
information0.00914534810831654NN
world0.00087176582269799NN
bank0NN

Label: 9, with a score of: 0.431956545652673
WordScorePoS
source0.0135141354781442NN
population0NN
figure0.0602029956716497NN
child0NN
country0NN
datum0.0454743001434393NN
malaria0NN
incidence0NN
information0.0675706773907211NN
world0.00257642711761688NN
bank0NN

Label: 2, with a score of: 0.367820683377656
WordScorePoS
source0.0130963126055467NN
population0.0310434135749871NN
figure0NN
child0.0546336178945768NN
country0NN
datum0NN
malaria0NN
incidence0NN
information0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Percentage of mildly moderately and severely underweight children under five years of age

Label: 3, with a score of: 0.594915110453463
WordScorePoS
percentage0NN
moderately0RB
severely0RB
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.47936838767793
WordScorePoS
percentage0NN
moderately0RB
severely0RB
child0.0450489732120807NN
age0.112994637345193NN

Label: 2, with a score of: 0.453509239590142
WordScorePoS
percentage0.0583416713841148NN
moderately0RB
severely0RB
child0.0546336178945768NN
age0.0365427838531249NN

Label: 4, with a score of: 0.308933869730951
WordScorePoS
percentage0NN
moderately0RB
severely0RB
child0.076326555629389NN
age0.0255262687343935NN

Two week days prevalence

Label: 1, with a score of: 0.94778253962935
WordScorePoS
day0.25973846344589NN
prevalence0NN

were reported to have had symptoms of acute respiratory illness and percent had diarrhea in the two weeks preceding the survey Ghana Statistical Service

Label: 0, with a score of: 1

Vectorborne or water based diseases such as malaria and schistosomiasis are rampant because of inadequate environmental management programs although some success has occurred in the increased use of bednets

Label: 6, with a score of: 0.745009872366032
WordScorePoS
water0.556409482163189NN
base0NN
disease0.103230094596636NN
malaria0NN
inadequate0.0836717266454039JJ
environmental0JJ
management0.0428007293971684NN
occur0VB
increase0.00905621749519576NN

Label: 3, with a score of: 0.496852912339257
WordScorePoS
water0.0382775468083574NN
base0.0149758277542848NN
disease0.215415047323213NN
malaria0.20370424488904NN
inadequate0JJ
environmental0JJ
management0.0127591822694525NN
occur0.0307735781890304VB
increase0.0143984997539974NN

Label: 12, with a score of: 0.329058781936816
WordScorePoS
water0.186896403054502NN
base0.0199423462679015NN
disease0NN
malaria0NN
inadequate0JJ
environmental0.0598270388037045JJ
management0.0339811641917276NN
occur0.0409791940864438VB
increase0.00958677785775002NN

Ghana is the only SubSaharan country to have dramatically improved food security according to its international pledges FAO

Label: 2, with a score of: 0.835778200467076
WordScorePoS
country0NN
improve0.0218534471578307VB
food0.292342270824999NN
security0.0893850849591018NN
international0.00515473144367677JJ

Label: 12, with a score of: 0.387064571332236
WordScorePoS
country0NN
improve0VB
food0.186896403054502NN
security0NN
international0.0023966944644375JJ

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Pakistan is country with million inhabitants see box

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
country0NN

In Pakistan population growth is coupled with trends in industrialization and urbanization

Label: 9, with a score of: 0.807017221179647
WordScorePoS
population0NN
growth0.0260040237236563NN
industrialization0.481623965373197NN
urbanization0NN

Label: 8, with a score of: 0.399650021818337
WordScorePoS
population0.0428212738652355NN
growth0.208565600657229NN
industrialization0NN
urbanization0NN

Label: 11, with a score of: 0.263483194401887
WordScorePoS
population0.0194583992186006NN
growth0NN
industrialization0NN
urbanization0.146277152173395NN

Label: 10, with a score of: 0.314532520723269
WordScorePoS
population0.0860640399817412NN
growth0.11178243319132NN
industrialization0NN
urbanization0NN

The under five mortality rate for Pakistan is estimated to be per live births

Label: 3, with a score of: 0.886080070410987
WordScorePoS
mortality0.276962203701274NN
rate0.0433561464459019NN
estimate0.059903311017139NN
live0.0300513417930436VB
birth0.0748292956291867NN

Both rural and urban areas suffer from underinvestment in water supply and sanitation

Label: 6, with a score of: 0.88758778057859
WordScorePoS
rural0JJ
urban0JJ
suffer0.041835863322702VB
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN

Label: 11, with a score of: 0.321573353030737
WordScorePoS
rural0.0373517915079663JJ
urban0.27622591898666JJ
suffer0VB
water0.0458109463416786NN
supply0NN
sanitation0NN

Label: 12, with a score of: 0.230134451164017
WordScorePoS
rural0JJ
urban0JJ
suffer0VB
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN

Label: 2, with a score of: 0.165260396217145
WordScorePoS
rural0.148975141598503JJ
urban0JJ
suffer0.0357189919948307VB
water0NN
supply0NN
sanitation0NN

Sewerage systems where they exist are usually poorly maintained and often contribute to the cross contamination of water systems and the groundwater

Label: 6, with a score of: 0.741962527056362
WordScorePoS
system0NN
exist0VB
poorly0RB
maintain0VB
contribute0VB
contamination0NN
water0.556409482163189NN

Label: 12, with a score of: 0.367407026918174
WordScorePoS
system0NN
exist0.0332151194779746VB
poorly0RB
maintain0VB
contribute0.0554128417527413VB
contamination0NN
water0.186896403054502NN

Label: 2, with a score of: 0.358882916738975
WordScorePoS
system0.0756001353333673NN
exist0VB
poorly0RB
maintain0.0881366997038154VB
contribute0.0297950283197006VB
contamination0NN
water0NN

In rural areas more than million people lack access to safe drinking water while million lack adequate sanitation

Label: 6, with a score of: 0.900268581934629
WordScorePoS
rural0JJ
people0.024149913320522NNS
lack0.0214003646985842NN
access0.00731085509381114NN
safe0.0428007293971684JJ
drinking0.206460189193271NN
water0.556409482163189NN
adequate0.0295155485671997JJ
sanitation0.334686906581616NN

Label: 12, with a score of: 0.162548347177163
WordScorePoS
rural0JJ
people0.0119834723221875NNS
lack0NN
access0.00232174891244877NN
safe0JJ
drinking0NN
water0.186896403054502NN
adequate0.0234335422829798JJ
sanitation0NN

Label: 2, with a score of: 0.145091488718565
WordScorePoS
rural0.148975141598503JJ
people0.0257736572183839NNS
lack0NN
access0.00749031153171887NN
safe0.0182713919265625JJ
drinking0NN
water0NN
adequate0JJ
sanitation0NN

Inadequate quantity and quality of potable water and poor sanitation facilities and hygiene practices are associated with host of illnesses such as diarrhea typhoid intestinal worms and hepatitis

Label: 6, with a score of: 0.922952633026573
WordScorePoS
inadequate0.0836717266454039JJ
quality0.0255958462813622NN
water0.556409482163189NN
poor0.0642010940957526JJ
sanitation0.334686906581616NN
facility0NN
hygiene0.136665345449673NN
practice0NN
illness0NN
hepatitis0NN

Label: 12, with a score of: 0.239337514075246
WordScorePoS
inadequate0JJ
quality0.0203215381458133NN
water0.186896403054502NN
poor0.0339811641917276JJ
sanitation0NN
facility0NN
hygiene0NN
practice0.0703006268489394NN
illness0NN
hepatitis0NN

Label: 1, with a score of: 0.172331686598482
WordScorePoS
inadequate0.0736315832425121JJ
quality0NN
water0NN
poor0.150659516460257JJ
sanitation0NN
facility0NN
hygiene0NN
practice0NN
illness0NN
hepatitis0NN

About percent of households use solid fuels for cooking in Pakistan Federal Bureau of Statistics

Label: 7, with a score of: 0.810684192145188
WordScorePoS
household0NN
fuel0.0749457204978913NN
cooking0.122412709674631NN

Label: 5, with a score of: 0.420542178983049
WordScorePoS
household0.0465610847355851NN
fuel0.0558185411034276NN
cooking0NN

Dehydration attributable to diarrhea is major cause of mortality among children in Pakistan

Label: 3, with a score of: 0.900352518129184
WordScorePoS
major0.0108390366114755JJ
mortality0.276962203701274NN
child0.10682408961305NN

In to some percent of children under five were reported to have suffered from diarrhea in the previous days Krupnick Larsen and Strukova

Label: 1, with a score of: 0.740278519645163
WordScorePoS
child0.0450489732120807NN
report0NN
suffer0VB
previous0JJ
day0.25973846344589NN

Label: 3, with a score of: 0.376943672294503
WordScorePoS
child0.10682408961305NN
report0.0307735781890304NN
suffer0VB
previous0JJ
day0.0175975629039954NN

Results for Ghana and Pakistan This part of the chapter presents and discusses the new estimates for the economic costs attributed to environmental risk factors in Ghana and Pakistan

Label: 8, with a score of: 0.365313173100046
WordScorePoS
result0NN
estimate0NN
economic0.128463821595706JJ
cost0NN
environmental0.0295821503613099JJ
risk0NN

Label: 10, with a score of: 0.446434190586398
WordScorePoS
result0NN
estimate0NN
economic0.103276847978089JJ
cost0.0660824365173543NN
environmental0.0237821918091848JJ
risk0NN

Label: 1, with a score of: 0.44413320998919
WordScorePoS
result0NN
estimate0NN
economic0.0959899298575892JJ
cost0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN

Label: 11, with a score of: 0.360281856463278
WordScorePoS
result0NN
estimate0NN
economic0.0389167984372011JJ
cost0NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN

Label: 12, with a score of: 0.348510828244772
WordScorePoS
result0NN
estimate0.0199423462679015NN
economic0.0433009429988926JJ
cost0.0277064208763707NN
environmental0.0598270388037045JJ
risk0NN

The first subsection presents the results of the costs from environmental risk factors excluding malnutrition alluding also to estimates provided in previous studies

Label: 1, with a score of: 0.495087557022408
WordScorePoS
result0NN
cost0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
malnutrition0.0736315832425121NN
estimate0NN
previous0JJ
study0NN

Label: 3, with a score of: 0.379925868845009
WordScorePoS
result0NN
cost0NN
environmental0JJ
risk0.0703902516159815NN
malnutrition0NN
estimate0.059903311017139NN
previous0JJ
study0NN

The next subsection presents the context and results for the total effects including malnutrition of these environmental risk factors

Label: 1, with a score of: 0.507600931544811
WordScorePoS
context0NN
result0NN
total0NN
effect0NN
include0VB
malnutrition0.0736315832425121NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN

Label: 6, with a score of: 0.417602635890116
WordScorePoS
context0NN
result0.0683326727248364NN
total0.0295155485671997NN
effect0NN
include0VB
malnutrition0.041835863322702NN
environmental0JJ
risk0NN

Label: 2, with a score of: 0.389211232916915
WordScorePoS
context0NN
result0NN
total0.0252000451111224NN
effect0.0440683498519077NN
include0VB
malnutrition0.0357189919948307NN
environmental0JJ
risk0.0252000451111224NN

Label: 11, with a score of: 0.349643689897402
WordScorePoS
context0NN
result0NN
total0NN
effect0NN
include0VB
malnutrition0NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN

Label: 12, with a score of: 0.318975116428231
WordScorePoS
context0NN
result0NN
total0.0468670845659596NN
effect0NN
include0VB
malnutrition0NN
environmental0.0598270388037045JJ
risk0NN

The final subsection presents estimates for the economic costs of poor school performance and lost work productivity that are attributed to impaired cognitive development and learning from the infection malnutrition links

Label: 4, with a score of: 0.586590417414732
WordScorePoS
final0JJ
estimate0.0299609328954485NN
economic0JJ
cost0NN
poor0JJ
school0.208127520578185NN
performance0NN
lose0VB
productivity0NN
development0.0279277626235394NN
learn0.244520809605025VB
infection0NN
malnutrition0NN

Label: 1, with a score of: 0.386931301204091
WordScorePoS
final0JJ
estimate0NN
economic0.0959899298575892JJ
cost0NN
poor0.150659516460257JJ
school0NN
performance0NN
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productivity0NN
development0.0164833460638534NN
learn0VB
infection0NN
malnutrition0.0736315832425121NN

Label: 8, with a score of: 0.201158932464016
WordScorePoS
final0JJ
estimate0NN
economic0.128463821595706JJ
cost0NN
poor0JJ
school0NN
performance0NN
lose0VB
productivity0.0410992516792148NN
development0.0055149369084567NN
learn0VB
infection0NN
malnutrition0NN

The Burden of Environmental Risk Factors If No Change in Malnutrition Earlier studies have reported the cost of environmental health effects in Ghana Larsen and the cost of environmental degradation in Pakistan Krupnick Larsen and Strukova

Label: 13, with a score of: 0.481942545707153
WordScorePoS
burden0NN
environmental0JJ
risk0NN
change0.402565546215053NN
malnutrition0NN
study0NN
report0NN
cost0.0279982034978914NN
health0NN
effect0NN
degradation0NN

Label: 15, with a score of: 0.35784670534626
WordScorePoS
burden0NN
environmental0JJ
risk0.0223459295604043NN
change0.0446918591208085NN
malnutrition0NN
study0.0517339898971162NN
report0NN
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health0NN
effect0NN
degradation0.221714625071441NN

Label: 3, with a score of: 0.307467822927102
WordScorePoS
burden0NN
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risk0.0703902516159815NN
change0NN
malnutrition0NN
study0NN
report0.0307735781890304NN
cost0NN
health0.191387734041787NN
effect0NN
degradation0NN

Label: 12, with a score of: 0.430378740307807
WordScorePoS
burden0NN
environmental0.0598270388037045JJ
risk0NN
change0NN
malnutrition0NN
study0NN
report0.0409791940864438NN
cost0.0277064208763707NN
health0.0339811641917276NN
effect0NN
degradation0.0996453584339239NN

In this study the same methodology is applied to recently published baseline data to estimate mortality from indoor air pollution and inadequate water supply sanitation and hygiene

Label: 6, with a score of: 0.881615245465064
WordScorePoS
study0NN
datum0NN
estimate0NN
mortality0NN
air0NN
pollution0.0590310971343993NN
inadequate0.0836717266454039JJ
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN

Label: 3, with a score of: 0.314421197143684
WordScorePoS
study0NN
datum0NN
estimate0.059903311017139NN
mortality0.276962203701274NN
air0.020806307400253NN
pollution0.0175975629039954NN
inadequate0JJ
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
hygiene0NN

Label: 12, with a score of: 0.255261148799486
WordScorePoS
study0NN
datum0NN
estimate0.0199423462679015NN
mortality0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
inadequate0JJ
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
hygiene0NN

This report uses WHO country estimates of cause specific mortality for adjusted to reflect underfive child mortality rates in

Label: 3, with a score of: 0.928704815644178
WordScorePoS
report0.0307735781890304NN
country0NN
estimate0.059903311017139NN
specific0JJ
mortality0.276962203701274NN
reflect0VB
child0.10682408961305NN
rate0.0433561464459019NN

Solid fuel use prevalence is also updated from the Pakistan Social and Living Standards Measurement Survey Federal Bureau of Statistics

Label: 1, with a score of: 0.558361937175251
WordScorePoS
fuel0NN
prevalence0NN
social0.112994637345193JJ
live0.0739258553811849VB
standard0NN
measurement0NN
survey0NN

Label: 10, with a score of: 0.543412608721897
WordScorePoS
fuel0NN
prevalence0NN
social0.101310366625194JJ
live0.0159075630937118VB
standard0NN
measurement0NN
survey0.064698038783335NN

Estimated environmentally attributable fractions of child mortality in Ghana and Pakistan are presented in table

Label: 3, with a score of: 0.930150874196561
WordScorePoS
estimate0.059903311017139NN
environmentally0RB
child0.10682408961305NN
mortality0.276962203701274NN

These fractions are estimated as follows

Label: 3, with a score of: 0.765883642519583
WordScorePoS
estimate0.059903311017139NN

Label: 4, with a score of: 0.383060435719248
WordScorePoS
estimate0.0299609328954485NN

The attributable fraction for acute lower respiratory infection ALRI is related ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL TABLE

Label: 3, with a score of: 0.754640899039243
WordScorePoS
infection0.122222546933424NN
related0.0125195145191824JJ
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
burden0NN
cost0NN
country0NN
level0NN

Label: 12, with a score of: 0.302865680835371
WordScorePoS
infection0NN
related0.00833571598658786JJ
estimate0.0199423462679015NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
cost0.0277064208763707NN
country0NN
level0.00513687014008325NN

Environmentally Attributable Fractions of Child Mortality Keeping Malnutrition Unchanged Disease Pneumonia ALRI Diarrhea Malaria Ghana Pakistan

Label: 3, with a score of: 0.950243531120282
WordScorePoS
environmentally0RB
child0.10682408961305NN
mortality0.276962203701274NN
malnutrition0NN
disease0.215415047323213NN
malaria0.20370424488904NN

Sources Compiled by World Bank team on the basis of Federal Bureau of Statistics Ghana Statistical Service Prüss Üstün and Corvalán

Label: 17, with a score of: 0.604165882217873
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN
basis0.048933054487825NN
statistical0.048933054487825JJ
service0NN

In the case of Ghana the subregional environmentally attributable fraction for malaria of percent may be an overestimate because of mosquito ecology which demands that environmental manipulation be supplemented by bednets and indoor residual spraying

Label: 3, with a score of: 0.882968848496748
WordScorePoS
environmentally0RB
malaria0.20370424488904NN
demand0.020806307400253NN
environmental0JJ

TABLE

Label: 0, with a score of: 1

Estimated Mortality in Under Five Children from Environmental Risk Factors Disease Under Child Mortality Ghana Mortality from Environmental Risk Factors Excluding Malnutrition Pneumonia ALRI Diarrhea Malaria Total Under Child Mortality Pakistan Mortality from Environmental Risk Factors Excluding Malnutrition Source Compiled by World Bank team on the basis of WHO

Label: 3, with a score of: 0.902691326642426
WordScorePoS
estimate0.059903311017139NN
mortality0.276962203701274NN
child0.10682408961305NN
environmental0JJ
risk0.0703902516159815NN
disease0.215415047323213NN
malnutrition0NN
malaria0.20370424488904NN
total0NN
source0NN
world0.00087176582269799NN
bank0NN
basis0NN

Includes all under five child mortality not just mortality from ALRI diarrhea and malaria

Label: 3, with a score of: 0.978558179478866
WordScorePoS
include0VB
child0.10682408961305NN
mortality0.276962203701274NN
malaria0.20370424488904NN

to indoor air pollution and is estimated from the share of households using solid fuels and the relative risk of ALRI in children from such fuel use that is relative risk equals

Label: 11, with a score of: 0.47538906404876
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN
estimate0NN
share0NN
household0NN
fuel0NN
relative0.0731385760866977JJ
risk0.0631828116343571NN
child0.0273960270556257NN
equal0JJ

Label: 3, with a score of: 0.445665844521813
WordScorePoS
air0.020806307400253NN
pollution0.0175975629039954NN
estimate0.059903311017139NN
share0NN
household0NN
fuel0NN
relative0JJ
risk0.0703902516159815NN
child0.10682408961305NN
equal0JJ

Label: 5, with a score of: 0.40975412657817
WordScorePoS
air0NN
pollution0NN
estimate0NN
share0.0285529457667019NN
household0.0465610847355851NN
fuel0.0558185411034276NN
relative0JJ
risk0NN
child0.0170753354211044NN
equal0.114211783066808JJ

as reported by Desai Mehta and Smith

Label: 12, with a score of: 0.799632853806177
WordScorePoS
report0.0409791940864438NN

About percent of households use solid fuels for cooking in Ghana Ghana Statistical Service and percent use such fuels in Pakistan Federal Bureau of Statistics

Label: 7, with a score of: 0.794686217627788
WordScorePoS
household0NN
fuel0.0749457204978913NN
cooking0.122412709674631NN
statistical0JJ
service0.0451471467893167NN

The attributable fraction for diarrhea is related to WSH and is based on regional estimates by WHO

Label: 1, with a score of: 0.532730347610703
WordScorePoS
related0.0184786920895884JJ
base0.0442083771593746NN
regional0.0519476926891779JJ
estimate0NN

Label: 3, with a score of: 0.406158779073808
WordScorePoS
related0.0125195145191824JJ
base0.0149758277542848NN
regional0JJ
estimate0.059903311017139NN

Label: 14, with a score of: 0.401489802672119
WordScorePoS
related0.0081738237776987JJ
base0.058665107245718NN
regional0JJ
estimate0.0195550357485727NN

The attributable fraction for malaria is related to water resource management and is from Prüss Üstün and Corvalán

Label: 6, with a score of: 0.813283158766797
WordScorePoS
malaria0NN
related0.0524959536790166JJ
water0.556409482163189NN
resource0.0104991907358033NN
management0.0428007293971684NN

Label: 12, with a score of: 0.332694062607261
WordScorePoS
malaria0NN
related0.00833571598658786JJ
water0.186896403054502NN
resource0.0416785799329393NN
management0.0339811641917276NN

Label: 3, with a score of: 0.328234213644181
WordScorePoS
malaria0.20370424488904NN
related0.0125195145191824JJ
water0.0382775468083574NN
resource0NN
management0.0127591822694525NN

Under five child mortality in was and per live births in Ghana and Pakistan respectively World Bank

Label: 3, with a score of: 0.837090283685027
WordScorePoS
child0.10682408961305NN
mortality0.276962203701274NN
live0.0300513417930436VB
birth0.0748292956291867NN
world0.00087176582269799NN
bank0NN

Those figures imply about annual deaths in Ghana and about in Pakistan

Label: 3, with a score of: 0.904953746480996
WordScorePoS
figure0NN
death0.193573191943949NN

Accordingly the mortality attributed to different diseases cause specific mortality is estimated from WHO

Label: 3, with a score of: 0.980347735037205
WordScorePoS
mortality0.276962203701274NN
disease0.215415047323213NN
specific0JJ
estimate0.059903311017139NN

The results show that when malnutrition is not fully accounted for environment related mortality is estimated at about children per year in Ghana and in Pakistan or about one third of all child mortality in each country table

Label: 3, with a score of: 0.840722321059305
WordScorePoS
result0NN
malnutrition0NN
fully0RB
account0NN
environment0NN
related0.0125195145191824JJ
mortality0.276962203701274NN
estimate0.059903311017139NN
child0.10682408961305NN
country0NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL The Burden of Environmental Risk Factors and Malnutrition This subsection presents the revised estimates in country context for assessing the effect on mortality relating to environmental risk factors such as poor WSH indoor air pollution inadequate water resource management and malnutrition

Label: 6, with a score of: 0.51319612805898
WordScorePoS
environmental0JJ
health0NN
child0.0255958462813622NN
burden0NN
risk0NN
malnutrition0.041835863322702NN
estimate0NN
country0NN
context0NN
effect0NN
mortality0NN
poor0.0642010940957526JJ
air0NN
pollution0.0590310971343993NN
inadequate0.0836717266454039JJ
water0.556409482163189NN
resource0.0104991907358033NN
management0.0428007293971684NN

Label: 3, with a score of: 0.479616560661551
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
burden0NN
risk0.0703902516159815NN
malnutrition0NN
estimate0.059903311017139NN
country0NN
context0NN
effect0NN
mortality0.276962203701274NN
poor0JJ
air0.020806307400253NN
pollution0.0175975629039954NN
inadequate0JJ
water0.0382775468083574NN
resource0NN
management0.0127591822694525NN

Label: 1, with a score of: 0.402982023458059
WordScorePoS
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
burden0NN
risk0.0519476926891779NN
malnutrition0.0736315832425121NN
estimate0NN
country0NN
context0NN
effect0NN
mortality0NN
poor0.150659516460257JJ
air0NN
pollution0NN
inadequate0.0736315832425121JJ
water0NN
resource0.0739147683583536NN
management0NN

Label: 12, with a score of: 0.337438446056184
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
burden0NN
risk0NN
malnutrition0NN
estimate0.0199423462679015NN
country0NN
context0NN
effect0NN
mortality0NN
poor0.0339811641917276JJ
air0.0554128417527413NN
pollution0.0234335422829798NN
inadequate0JJ
water0.186896403054502NN
resource0.0416785799329393NN
management0.0339811641917276NN

Label: 11, with a score of: 0.326637903831758
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
child0.0273960270556257NN
burden0NN
risk0.0631828116343571NN
malnutrition0NN
estimate0NN
country0NN
context0NN
effect0NN
mortality0NN
poor0.0229054731708393JJ
air0.0373517915079663NN
pollution0.0315914058171786NN
inadequate0JJ
water0.0458109463416786NN
resource0.0449504361447405NN
management0.0687164195125178NN

First the subsection presents child malnutrition status in the two countries to provide sense of the prevalence of stunting and underweight in children see table

Label: 2, with a score of: 0.527642632002359
WordScorePoS
child0.0546336178945768NN
malnutrition0.0357189919948307NN
status0NN
country0NN
provide0.0215170467912497VB
sense0NN
prevalence0NN
stunt0.11668334276823NN

Label: 3, with a score of: 0.492650232071007
WordScorePoS
child0.10682408961305NN
malnutrition0NN
status0NN
country0NN
provide0.0100171139310145VB
sense0NN
prevalence0.0407408489778079NN
stunt0NN

Label: 1, with a score of: 0.360162687379647
WordScorePoS
child0.0450489732120807NN
malnutrition0.0736315832425121NN
status0NN
country0NN
provide0.0295703421524739VB
sense0NN
prevalence0NN
stunt0NN

Label: 10, with a score of: 0.301911667806384
WordScorePoS
child0.0242343960710022NN
malnutrition0NN
status0.0488696285210061NN
country0NN
provide0VB
sense0.064698038783335NN
prevalence0NN
stunt0NN

Second it examines the relationship between diarrheal infections and malnutrition status and estimates the malnutrition rates in the absence of infections

Label: 3, with a score of: 0.787058024422817
WordScorePoS
infection0.122222546933424NN
malnutrition0NN
status0NN
estimate0.059903311017139NN
rate0.0433561464459019NN

Label: 1, with a score of: 0.478196462926555
WordScorePoS
infection0NN
malnutrition0.0736315832425121NN
status0NN
estimate0NN
rate0.0639932865717261NN

Third the subsection estimates the impact of environmental factors including the effect of infections on malnutrition on health outcomes in children under five mortality

Label: 3, with a score of: 0.847011682847332
WordScorePoS
estimate0.059903311017139NN
impact0NN
environmental0JJ
include0VB
effect0NN
infection0.122222546933424NN
malnutrition0NN
health0.191387734041787NN
outcome0NN
child0.10682408961305NN
mortality0.276962203701274NN

Finally separate subsection addresses the effect of infectionmalnutrition links on cognition and learning as well as the accompanying effects on education and costs of lifetime income losses

Label: 4, with a score of: 0.73630129158683
WordScorePoS
address0NN
effect0NN
learn0.244520809605025VB
education0.244244978014045NN
cost0NN
income0NN
loss0NN

Label: 10, with a score of: 0.466055024785827
WordScorePoS
address0.064698038783335NN
effect0NN
learn0VB
education0.0121171980355011NN
cost0.0660824365173543NN
income0.166475342664294NN
loss0NN

Label: 9, with a score of: 0.337668701363231
WordScorePoS
address0NN
effect0.0454743001434393NN
learn0VB
education0.022550656390892NN
cost0NN
income0.110649350233433NN
loss0NN

Malnutrition in Ghana and Pakistan

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

Label: 6, with a score of: 0.455176256376397
WordScorePoS
malnutrition0.041835863322702NN

Label: 2, with a score of: 0.388624394633276
WordScorePoS
malnutrition0.0357189919948307NN

Malnutrition prevalence is high in many developing countries

Label: 1, with a score of: 0.732389301348469
WordScorePoS
malnutrition0.0736315832425121NN
prevalence0NN
develop0VB
country0NN

Label: 6, with a score of: 0.416127663713378
WordScorePoS
malnutrition0.041835863322702NN
prevalence0NN
develop0VB
country0NN

Label: 3, with a score of: 0.40523591379158
WordScorePoS
malnutrition0NN
prevalence0.0407408489778079NN
develop0VB
country0NN

In Ghana about percent of children under the age of five years were mildly moderately or severely underweight in which is still percentage points less than the average in Sub Saharan Africa Fishman and others

Label: 10, with a score of: 0.411306527552771
WordScorePoS
child0.0242343960710022NN
age0.0202620733250388NN
moderately0RB
severely0RB
percentage0NN
average0.146608885563018NN
saharan0JJ
africa0IN

Label: 13, with a score of: 0.356505216096002
WordScorePoS
child0NN
age0NN
moderately0RB
severely0RB
percentage0NN
average0.1656430212089NN
saharan0JJ
africa0IN

Label: 3, with a score of: 0.486602280061528
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN
moderately0RB
severely0RB
percentage0NN
average0NN
saharan0.0299516555085695JJ
africa0IN

Label: 1, with a score of: 0.43529686950008
WordScorePoS
child0.0450489732120807NN
age0.112994637345193NN
moderately0RB
severely0RB
percentage0NN
average0NN
saharan0.0442083771593746JJ
africa0IN

Label: 2, with a score of: 0.367956741611536
WordScorePoS
child0.0546336178945768NN
age0.0365427838531249NN
moderately0RB
severely0RB
percentage0.0583416713841148NN
average0NN
saharan0.0214456704626236JJ
africa0IN

About percent of children under five in Pakistan were mildly moderately or severely underweight in with minimal change in to

Label: 13, with a score of: 0.854066126150687
WordScorePoS
child0NN
moderately0RB
severely0RB
change0.402565546215053NN

An important feature of malnutrition rates in developing countries such as Ghana and Pakistan is that it tends to rise very quickly in the first stages of life and then levels off or declines

Label: 13, with a score of: 0.528089934831216
WordScorePoS
feature0NN
malnutrition0NN
rate0NN
develop0VB
country0NN
rise0.120914181920259NN
quickly0RB
stage0NN
life0.00842350130803634NN
level0.0415277415054218NN
decline0.0236803262479443NN

Label: 1, with a score of: 0.454650502424079
WordScorePoS
feature0NN
malnutrition0.0736315832425121NN
rate0.0639932865717261NN
develop0VB
country0NN
rise0NN
quickly0RB
stage0NN
life0.0184786920895884NN
level0.0113874611101829NN
decline0NN

More than percent of the children in the Ghana Demographic and Health Survey Ghana Statistical Service were not underweight in their first three months of life moderate and severe underweight was TABLE

Label: 3, with a score of: 0.745646210354375
WordScorePoS
child0.10682408961305NN
health0.191387734041787NN
survey0NN
statistical0JJ
service0.0100171139310145NN
life0.0250390290383647NN

Malnutrition Rates in Children under the Age of Five Malnutrition Rate Indicator Underweight weight for age Mild − to − SD Moderate − to − SD Severe less than − SD Total less than − SD Stunting height for age Mild − to − SD Moderate − to − SD Severe less than − SD Total less than − SD Ghana Pakistan Sources Compiled by World Bank team on the basis of data from Ghana Statistical Service National Institute of Population Studies

Label: 0, with a score of: 1

Figures in parentheses are based on PIDE

Label: 9, with a score of: 0.592406721558523
WordScorePoS
figure0.0602029956716497NN
base0NN

Label: 14, with a score of: 0.577273663305111
WordScorePoS
figure0NN
base0.058665107245718NN

Label: 1, with a score of: 0.435017219429508
WordScorePoS
figure0NN
base0.0442083771593746NN

ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL practically nonexistent in this age group

Label: 3, with a score of: 0.680156846867851
WordScorePoS
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
burden0NN
cost0NN
country0NN
level0NN
age0.0893142758861673NN

Label: 1, with a score of: 0.336659351028062
WordScorePoS
estimate0NN
environmental0.0442083771593746JJ
health0NN
burden0NN
cost0NN
country0NN
level0.0113874611101829NN
age0.112994637345193NN

Label: 10, with a score of: 0.300835599615717
WordScorePoS
estimate0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN
cost0.0660824365173543NN
country0NN
level0NN
age0.0202620733250388NN

The prevalence of moderate and severe underweight peaked at over percent in children to months of age however and then gradually declined to the age of five years

Label: 3, with a score of: 0.702736708985502
WordScorePoS
prevalence0.0407408489778079NN
child0.10682408961305NN
age0.0893142758861673NN
decline0.0351951258079907NN

Label: 1, with a score of: 0.527046281529671
WordScorePoS
prevalence0NN
child0.0450489732120807NN
age0.112994637345193NN
decline0NN

The prevalence of mild underweight reached about percent in children age to months and then leveled off to the age of five years

Label: 3, with a score of: 0.592874650043378
WordScorePoS
prevalence0.0407408489778079NN
reach0NN
child0.10682408961305NN
age0.0893142758861673NN
level0NN

Label: 1, with a score of: 0.513324294754293
WordScorePoS
prevalence0NN
reach0NN
child0.0450489732120807NN
age0.112994637345193NN
level0.0113874611101829NN

Label: 4, with a score of: 0.364298566110953
WordScorePoS
prevalence0NN
reach0.0499016491051341NN
child0.076326555629389NN
age0.0255262687343935NN
level0.0231525547935232NN

Label: 16, with a score of: 0.340377618843979
WordScorePoS
prevalence0NN
reach0.0658099748168827NN
child0.0603953832457135NN
age0NN
level0.0610668815653026NN

A similar evolution can be inferred from Pakistani data

Label: 17, with a score of: 0.851744941703599
WordScorePoS
datum0.0739231123597559NN

More than percent of the children were not underweight in their first month of life but by to months of age the prevalence of moderate and severe underweight rose rapidly to percent stabilizing to mean of percent for children age to months

Label: 3, with a score of: 0.649832356774541
WordScorePoS
child0.10682408961305NN
life0.0250390290383647NN
age0.0893142758861673NN
prevalence0.0407408489778079NN
rise0NN
rapidly0RB

In global comparisons too children to months of age in Ghana and Pakistan have similar weight for age scores indicator for underweight to the international reference population but the scores fall considerably below the international reference during the first year of life see figure

Label: 3, with a score of: 0.64978844082854
WordScorePoS
global0.013959557403375JJ
child0.10682408961305NN
age0.0893142758861673NN
international0JJ
population0NN
fall0.123094312756122NN
life0.0250390290383647NN
figure0NN

By the age of to months children from both countries are significantly underweight with more than percent malnourished

Label: 3, with a score of: 0.637519347266509
WordScorePoS
age0.0893142758861673NN
child0.10682408961305NN
country0NN
significantly0RB

Label: 1, with a score of: 0.513697864187194
WordScorePoS
age0.112994637345193NN
child0.0450489732120807NN
country0NN
significantly0RB

Label: 4, with a score of: 0.331057852656104
WordScorePoS
age0.0255262687343935NN
child0.076326555629389NN
country0NN
significantly0RB

Health effects of malnutrition

Label: 3, with a score of: 0.756841186238838
WordScorePoS
health0.191387734041787NN
effect0NN
malnutrition0NN

Label: 9, with a score of: 0.328946236198549
WordScorePoS
health0.0377086395700813NN
effect0.0454743001434393NN
malnutrition0NN

Label: 2, with a score of: 0.315518372963988
WordScorePoS
health0NN
effect0.0440683498519077NN
malnutrition0.0357189919948307NN

The malnutrition attributable fractions for different diseases are calculated for Ghana and Pakistan see table

Label: 3, with a score of: 0.791105538121607
WordScorePoS
malnutrition0NN
disease0.215415047323213NN

Label: 6, with a score of: 0.53275053961626
WordScorePoS
malnutrition0.041835863322702NN
disease0.103230094596636NN

using estimates of increased risk of cause specific mortality and all cause mortality in children under five years of age with varying levels of malnutrition

Label: 3, with a score of: 0.883852684079605
WordScorePoS
estimate0.059903311017139NN
increase0.0143984997539974NN
risk0.0703902516159815NN
specific0JJ
mortality0.276962203701274NN
child0.10682408961305NN
age0.0893142758861673NN
level0NN
malnutrition0NN

The results indicate that in Ghana to percent of under five mortality from pneumonia ALRI diarrhea measles malaria and other causes is due to malnutrition

Label: 3, with a score of: 0.9171241008771
WordScorePoS
result0NN
mortality0.276962203701274NN
measles0.0407408489778079NNS
malaria0.20370424488904NN
due0JJ
malnutrition0NN

The corresponding attributable fractions for Pakistan are in the range of to percent because of higher underweight malnutrition rates in Pakistan

Label: 1, with a score of: 0.727834417643107
WordScorePoS
range0NN
malnutrition0.0736315832425121NN
rate0.0639932865717261NN

In addition to these malnutritionrelated mortalities Fishman and others include percent of protein energy malnutrition mortality and morbidity and share of mortality from perinatal conditions low birth weight associated with mothers low pre pregnancy body mass index less than kilograms per square meter

Label: 3, with a score of: 0.849011906363152
WordScorePoS
addition0NN
mortality0.276962203701274NN
include0VB
protein0NN
energy0NN
malnutrition0NN
share0NN
condition0NN
birth0.0748292956291867NN
mother0.162963395911232NN

Label: 7, with a score of: 0.423405333956334
WordScorePoS
addition0NN
mortality0NN
include0VB
protein0NN
energy0.494617163780726NN
malnutrition0NN
share0.0383371018038178NN
condition0NN
birth0NN
mother0NN

Label: 12, with a score of: 0.138981168008654
WordScorePoS
addition0NN
mortality0NN
include0VB
protein0NN
energy0.133960988253756NN
malnutrition0NN
share0NN
condition0.0409791940864438NN
birth0NN
mother0NN

About percent of infants had low birth weight less than grams in Ghana in as did about percent of infants in Pakistan in the past decade UNICEF

Label: 13, with a score of: 0.594964206859313
WordScorePoS
infant0NN
birth0NN
decade0.124232265906675NN

Infections and malnutrition

Label: 3, with a score of: 0.799232105859932
WordScorePoS
infection0.122222546933424NN
malnutrition0NN

Label: 1, with a score of: 0.48148829172059
WordScorePoS
infection0NN
malnutrition0.0736315832425121NN

Household survey data from Ghana and Pakistan provide some insights into the close links between diarrheal prevalence and underweight in children

Label: 3, with a score of: 0.504580445404284
WordScorePoS
household0NN
survey0NN
datum0NN
provide0.0100171139310145VB
prevalence0.0407408489778079NN
child0.10682408961305NN

Label: 10, with a score of: 0.390561737395886
WordScorePoS
household0.0330412182586772NN
survey0.064698038783335NN
datum0NN
provide0VB
prevalence0NN
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In Ghana the two week diarrheal prevalence was to percent in children under five years and to percent in children under three years according to the three most recent demographic and household surveys

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WordScorePoS
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This diarrheal prevalence differs dramatically by degree of underweight in Ghanaian children age to months panel of figure

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WordScorePoS
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WordScorePoS
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with prevalence in severely underweight children age to months reaching

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WordScorePoS
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WordScorePoS
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WordScorePoS
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WordScorePoS
prevalence0NN
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times higher than that in children who are not underweight

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WordScorePoS
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WordScorePoS
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WordScorePoS
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WordScorePoS
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A similar pattern although with less drastic differences across malnutrition categories exists in Pakistan

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WordScorePoS
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With two week diarrheal prevalence of percent in children under five years the prevalence in ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE

Label: 3, with a score of: 0.785716359313597
WordScorePoS
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Weight for Age Distribution of Children in Ghana and Pakistan a

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WordScorePoS
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child0.10682408961305NN

Label: 1, with a score of: 0.513697864187194
WordScorePoS
age0.112994637345193NN
child0.0450489732120807NN

Label: 4, with a score of: 0.331057852656104
WordScorePoS
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Ghana −

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

standard deviation from the mean weight of the international reference population age − months age − months b

Label: 0, with a score of: 1

Pakistan −

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

−

Label: 0, with a score of: 1

standard deviation from the mean weight of the international reference population age − months age − months Sources Compiled by World Bank team on the basis of data from Ghana Statistical Service National Institute of Population Studies

Label: 0, with a score of: 1

TABLE

Label: 0, with a score of: 1

Malnutrition Attributable Fractions of Child Mortality Cause of death Pneumonia ALRI Diarrhea Malaria Measles Protein energy malnutrition Other causes excluding perinatal conditions Ghana Pakistan

Label: 3, with a score of: 0.778970819697617
WordScorePoS
malnutrition0NN
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mortality0.276962203701274NN
death0.193573191943949NN
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measles0.0407408489778079NNS
protein0NN
energy0NN
condition0NN

Label: 7, with a score of: 0.468836931910209
WordScorePoS
malnutrition0NN
child0NN
mortality0NN
death0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN
condition0NN

Label: 12, with a score of: 0.165822022287428
WordScorePoS
malnutrition0NN
child0NN
mortality0NN
death0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN
condition0.0409791940864438NN

Source Compiled by World Bank team on the basis of Fishman and others

Label: 2, with a score of: 0.643093992808995
WordScorePoS
source0.0130963126055467NN
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Label: 17, with a score of: 0.571557108162646
WordScorePoS
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ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL FIGURE

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WordScorePoS
estimate0.059903311017139NN
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Label: 12, with a score of: 0.357917872326057
WordScorePoS
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Label: 9, with a score of: 0.347120152309878
WordScorePoS
estimate0.0221298700466866NN
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health0.0377086395700813NN
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cost0NN
country0NN
level0NN
figure0.0602029956716497NN

Label: 10, with a score of: 0.31835220924536
WordScorePoS
estimate0NN
environmental0.0237821918091848JJ
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Two Week Diarrheal Prevalence Rate by Age and Underweight Status in Ghana and Pakistan a

Label: 1, with a score of: 0.61927183856279
WordScorePoS
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rate0.0639932865717261NN
age0.112994637345193NN
status0NN

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WordScorePoS
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Ghana percentage of children with diarrhea age − months age − months not underweight moderately underweight b

Label: 3, with a score of: 0.601238252374897
WordScorePoS
percentage0NN
child0.10682408961305NN
age0.0893142758861673NN
moderately0RB

Label: 1, with a score of: 0.570877752977682
WordScorePoS
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moderately0RB

Label: 2, with a score of: 0.391893043785053
WordScorePoS
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moderately0RB

Pakistan percentage of children with diarrhea mildly underweight severely underweight age − months age − months age − months not underweight moderately underweight age − months age − months mildly underweight severely underweight Source Compiled by World Bank team on the basis of data from Ghana Statistical Service National Institute of Population Studies

Label: 0, with a score of: 1

severely underweight children is percent higher than in children who are not underweight panel of figure

Label: 3, with a score of: 0.598235038528584
WordScorePoS
severely0RB
child0.10682408961305NN
panel0NN
figure0NN

Because these data are cross sectional both indicators measured at the same point in time no causal relationship between underweight and diarrheal prevalence can be determined

Label: 0, with a score of: 1

However the pattern is consistent with research findings in other countries that show that diarrheal infections lead to weight gain retardation in children under five years

Label: 3, with a score of: 0.651756305018164
WordScorePoS
pattern0NN
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Label: 12, with a score of: 0.396038826027979
WordScorePoS
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This research literature finds that the weight gain retardation often is in the range of to percent

Label: 9, with a score of: 0.753986645761241
WordScorePoS
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Diarrheal infections are ENVIRONMENTAL HEALTH AND CHILD SURVIVAL most frequent during ages to months and to months so weight gain retardation from diarrheal infections can be expected to be greatest in this period in Ghana and Pakistan it is particularly great up to the age of months during which underweight malnutrition increases rapidly

Label: 3, with a score of: 0.763052995407935
WordScorePoS
infection0.122222546933424NN
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malnutrition0NN
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rapidly0RB

Label: 1, with a score of: 0.403345314265153
WordScorePoS
infection0NN
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Malnutrition in the absence of infections the counterfactual

Label: 3, with a score of: 0.799232105859932
WordScorePoS
malnutrition0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.48148829172059
WordScorePoS
malnutrition0.0736315832425121NN
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Results from the research literature are used to estimate the retarding effect that diarrheal infections have on weight gain

Label: 3, with a score of: 0.626564580421335
WordScorePoS
result0NN
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Label: 9, with a score of: 0.538400448603028
WordScorePoS
result0NN
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Label: 6, with a score of: 0.3456164643531
WordScorePoS
result0.0683326727248364NN
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This information sheds light on an important question what would be the counterfactual level of malnutrition in children who were not exposed to diarrheal infections

Label: 3, with a score of: 0.628914070617571
WordScorePoS
information0.00914534810831654NN
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Label: 16, with a score of: 0.384414586386335
WordScorePoS
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Label: 1, with a score of: 0.343427200131755
WordScorePoS
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malnutrition0.0736315832425121NN
child0.0450489732120807NN
infection0NN

Label: 4, with a score of: 0.310970378300166
WordScorePoS
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Current underweight malnutrition rates in children under five years from the demographic and health survey in Ghana Ghana Statistical Service and the survey in Pakistan National Institute of Population Studies as well as the estimated malnutrition rates in the absence of diarrheal infections that retard weight gain are presented in figure

Label: 3, with a score of: 0.619673035217751
WordScorePoS
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Basically the figures for both Ghana and Pakistan starkly show that in the absence of diarrheal infections children under five years in both countries would climb up the nutritional status ladder with practically no severely underweight children in either country and with the number of moderately underweight also substantially reduced

Label: 3, with a score of: 0.702056717602555
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Calculating the burden of environmental risk factors including malnutritionmediated effects

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WordScorePoS
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environmental0.0537696560159885JJ
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Label: 2, with a score of: 0.496158099233068
WordScorePoS
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WordScorePoS
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Information from the previous subsections provides the necessary building blocks for estimating the effects of environmental health risk factors

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Label: 17, with a score of: 0.313222015260878
WordScorePoS
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risk0NN

Label: 11, with a score of: 0.390935968531453
WordScorePoS
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Label: 9, with a score of: 0.355318765029349
WordScorePoS
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The counterfactual population exposure rates estimated are used to compare the current world with world without environmental risk factors in order to compute the environmental health risk that is the attributable fraction table

Label: 3, with a score of: 0.595279334304315
WordScorePoS
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Label: 1, with a score of: 0.485589687894747
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Appendix equation D

Label: 0, with a score of: 1

In making these estimates the study takes conservative approach

Label: 9, with a score of: 0.55311008168341
WordScorePoS
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Label: 3, with a score of: 0.402428908075981
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In fact the parameters on which attributable fractions are based are likely to be affected by omitted variable bias see appendix

Label: 0, with a score of: 1

To deal with this problem the study attempted to correct such parameters by using formulas from econometrics literature

Label: 0, with a score of: 1

The methodology is graphically represented in figure

Label: 9, with a score of: 0.677198936001337
WordScorePoS
represent0VB
figure0.0602029956716497NN

Label: 6, with a score of: 0.580596608559458
WordScorePoS
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Label: 14, with a score of: 0.452005729175985
WordScorePoS
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The indirect effect of environmental health risks is equivalent to the difference in mortality between the malnutrition attributable fractions of different diseases right bar and the consequences of malnutrition in the absence of diarrheal infections center bar

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WordScorePoS
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Notice that the joint direct and indirect effects of environmental health risks left bar are not necessarily equal to the sum of the two effects computed separately

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WordScorePoS
direct0JJ
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environmental0JJ
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Label: 11, with a score of: 0.388414116383658
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equal0JJ

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This problem is common in the presence of risk factors that interact with each other see box

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risk0.0703902516159815NN

Label: 11, with a score of: 0.630635834806428
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Figure

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

shows that additional pneumonia ALRI diarrhea malaria measles protein energy malnutrition and other deaths represented in the light gray area have not been accounted for previously

Label: 7, with a score of: 0.659341669139437
WordScorePoS
additional0JJ
malaria0NN
measles0NNS
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Label: 12, with a score of: 0.255536791333633
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The results shown in table

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demonstrate that when both direct and indirect effects from diarrheal infections on malnutrition are included the mortality ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL FIGURE

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Underweight Malnutrition Rates in Children with and without Diarrheal Infections in Ghana and Pakistan a

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malnutrition0NN
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Label: 1, with a score of: 0.4672929619504
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infection0NN

Label: 16, with a score of: 0.300806069663525
WordScorePoS
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Ghana underweight malnutrition rate without infections with infections severe moderate not underweight b

Label: 3, with a score of: 0.862152149715127
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malnutrition0NN
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infection0.122222546933424NN

Label: 1, with a score of: 0.412276115404058
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Pakistan underweight malnutrition rate mild with infections severe moderate without infections mild not underweight Sources Compiled by World Bank team on the basis of data from Ghana Statistical Service National Institute of Population Studies

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
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Environmentally Attributable Fractions and Child Mortality with Malnutrition Mediated Effects Disease Pneumonia ALRI Diarrhea Malaria Measles Protein energy malnutrition Other causes excluding perinatal conditions Total Ghana Revised Effects Number of Attributable Deaths Fraction Pakistan Revised Effects Number of Attributable Deaths Fraction

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WordScorePoS
environmentally0RB
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Source Compiled by World Bank team

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bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

FIGURE

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

Calculating Revised Estimates Indirect and Direct Effects indirect effect of environmental health risks direct effect of environmental health risks disease or illness caused by environmental risks consequences of malnutrition actual consequences of malnutrition counterfactual disease or illness caused by malnutrition Source Compiled by World Bank team

Label: 3, with a score of: 0.714270815792249
WordScorePoS
estimate0.059903311017139NN
direct0JJ
effect0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
disease0.215415047323213NN
illness0.0407408489778079NN
cause0NN
malnutrition0NN
actual0JJ
source0NN
world0.00087176582269799NN
bank0NN

from environmental factors is estimated at in Ghana and in Pakistan annually or about percent of all child mortality in both countries

Label: 3, with a score of: 0.87977674084495
WordScorePoS
environmental0JJ
estimate0.059903311017139NN
annually0RB
child0.10682408961305NN
mortality0.276962203701274NN
country0NN

Translating those deaths into economic costs will help quantify the magnitude of environmental health risks in real terms

Label: 3, with a score of: 0.654106017226288
WordScorePoS
death0.193573191943949NN
economic0JJ
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
term0NN

Label: 8, with a score of: 0.227030973763911
WordScorePoS
death0NN
economic0.128463821595706JJ
cost0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
term0NN

Label: 17, with a score of: 0.215176251860935
WordScorePoS
death0NN
economic0JJ
cost0NN
environmental0JJ
health0NN
risk0NN
term0.149793392961411NN

Label: 10, with a score of: 0.392557726754985
WordScorePoS
death0NN
economic0.103276847978089JJ
cost0.0660824365173543NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN
term0.0396106020715138NN

Label: 11, with a score of: 0.302188218858591
WordScorePoS
death0.0315914058171786NN
economic0.0389167984372011JJ
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
term0NN

In this analysis the human capital approach conservative approach is used to value this mortality

Label: 3, with a score of: 0.870850540072203
WordScorePoS
human0JJ
approach0NN
conservative0JJ
mortality0.276962203701274NN

For Ghana the earlier estimates of costs of environmental factors add up to million US million which is equivalent to

Label: 12, with a score of: 0.611751412205327
WordScorePoS
estimate0.0199423462679015NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
add0VB
equivalent0.0664302389559493JJ

Label: 8, with a score of: 0.560474959080257
WordScorePoS
estimate0NN
cost0NN
environmental0.0295821503613099JJ
add0.0804764811724088VB
equivalent0.049270765107907JJ

Label: 10, with a score of: 0.316117897548863
WordScorePoS
estimate0NN
cost0.0660824365173543NN
environmental0.0237821918091848JJ
add0VB
equivalent0JJ

percent of the country GDP

Label: 14, with a score of: 1
WordScorePoS
country0NN
gdp0.0531983120572613NN

ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL BOX

Label: 3, with a score of: 0.639815343813585
WordScorePoS
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
burden0NN
cost0NN
country0NN
level0NN

Label: 12, with a score of: 0.373244451657926
WordScorePoS
estimate0.0199423462679015NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
cost0.0277064208763707NN
country0NN
level0.00513687014008325NN

Label: 10, with a score of: 0.331984527628247
WordScorePoS
estimate0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN
cost0.0660824365173543NN
country0NN
level0NN

Attributable Fractions and Burden of Disease When Multiple Risk Factors Are Present The concept of an attributable fraction AF is the essential building block of the burden of disease methodology

Label: 3, with a score of: 0.777202697852735
WordScorePoS
burden0NN
disease0.215415047323213NN
multiple0JJ
risk0.0703902516159815NN
essential0.059903311017139JJ
building0NN

Label: 17, with a score of: 0.377845745686541
WordScorePoS
burden0.036961556179878NN
disease0NN
multiple0.048933054487825JJ
risk0NN
essential0JJ
building0.149940347231585NN

An AF tells what proportion of disease is caused by any given risk factor or combination of risk factors

Label: 3, with a score of: 0.795806804103697
WordScorePoS
proportion0.025518364538905NN
disease0.215415047323213NN
cause0NN
risk0.0703902516159815NN

Label: 11, with a score of: 0.35680500449341
WordScorePoS
proportion0NN
disease0NN
cause0.04477822029736NN
risk0.0631828116343571NN

Label: 6, with a score of: 0.304448747472294
WordScorePoS
proportion0.0428007293971684NN
disease0.103230094596636NN
cause0NN
risk0NN

To take into account the total effects of environmental risks on child health including those effects mediated through malnutrition one needs to allow for the simultaneous presence of multiple risk factors

Label: 3, with a score of: 0.605131644884723
WordScorePoS
account0NN
total0NN
effect0NN
environmental0JJ
risk0.0703902516159815NN
child0.10682408961305NN
health0.191387734041787NN
include0VB
malnutrition0NN
multiple0JJ

Label: 1, with a score of: 0.367750468273912
WordScorePoS
account0NN
total0NN
effect0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
child0.0450489732120807NN
health0NN
include0VB
malnutrition0.0736315832425121NN
multiple0JJ

Label: 2, with a score of: 0.350251141851784
WordScorePoS
account0NN
total0.0252000451111224NN
effect0.0440683498519077NN
environmental0JJ
risk0.0252000451111224NN
child0.0546336178945768NN
health0NN
include0VB
malnutrition0.0357189919948307NN
multiple0JJ

Label: 11, with a score of: 0.344469530084748
WordScorePoS
account0.0194583992186006NN
total0NN
effect0NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN
child0.0273960270556257NN
health0.0229054731708393NN
include0VB
malnutrition0NN
multiple0JJ

Whether one or more risk factors are being controlled should be clearly stated when one calculates AFs

Label: 1, with a score of: 0.650826234651728
WordScorePoS
risk0.0519476926891779NN
control0.0614198493690006NN

Label: 3, with a score of: 0.52354591129153
WordScorePoS
risk0.0703902516159815NN
control0.020806307400253NN

Label: 11, with a score of: 0.362723144950918
WordScorePoS
risk0.0631828116343571NN
control0NN

Tables

Label: 0, with a score of: 1

present the fraction of deaths that are in turn attributed to environmental health risks alone table

Label: 3, with a score of: 0.871524804622455
WordScorePoS
death0.193573191943949NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN

Label: 11, with a score of: 0.328147517084808
WordScorePoS
death0.0315914058171786NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN

malnutrition alone table

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

Label: 6, with a score of: 0.455176256376397
WordScorePoS
malnutrition0.041835863322702NN

Label: 2, with a score of: 0.388624394633276
WordScorePoS
malnutrition0.0357189919948307NN

and all relevant environmental health risks including their effect through malnutrition table

Label: 3, with a score of: 0.625479387554706
WordScorePoS
relevant0JJ
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
include0VB
effect0NN
malnutrition0NN

Label: 1, with a score of: 0.405682231081827
WordScorePoS
relevant0JJ
environmental0.0442083771593746JJ
health0NN
risk0.0519476926891779NN
include0VB
effect0NN
malnutrition0.0736315832425121NN

Label: 11, with a score of: 0.334169655059767
WordScorePoS
relevant0JJ
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
include0VB
effect0NN
malnutrition0NN

This calculation is made for specific causes of death for example ALRI diarrhea malaria measles and protein energy malnutrition

Label: 7, with a score of: 0.69174890276043
WordScorePoS
specific0JJ
death0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN
malnutrition0NN

Label: 3, with a score of: 0.612592305294421
WordScorePoS
specific0JJ
death0.193573191943949NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
protein0NN
energy0NN
malnutrition0NN

Label: 12, with a score of: 0.263226016040393
WordScorePoS
specific0.0542519672965169JJ
death0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN
malnutrition0NN

AFs in tables

Label: 0, with a score of: 1

measure the cases of death from disease that would be eliminated by removing risk factor from the population while leaving the exposure to other risk factors unchanged

Label: 3, with a score of: 0.71941059767914
WordScorePoS
measure0NN
death0.193573191943949NN
disease0.215415047323213NN
eliminate0VB
remove0VB
risk0.0703902516159815NN
population0NN
leave0NN
exposure0NN

Label: 1, with a score of: 0.429285420268139
WordScorePoS
measure0.103895385378356NN
death0NN
disease0NN
eliminate0VB
remove0VB
risk0.0519476926891779NN
population0NN
leave0NN
exposure0.120266261535276NN

Take Ghana as an example

Label: 0, with a score of: 1

The fraction of ALRI attributable to indoor air pollution is

Label: 14, with a score of: 0.605812469342387
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN

Label: 12, with a score of: 0.497027388029788
WordScorePoS
air0.0554128417527413NN
pollution0.0234335422829798NN

Label: 11, with a score of: 0.434600238273636
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN

percent table

Label: 0, with a score of: 1

and the fraction of ALRI attributable to malnutrition is

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

Label: 6, with a score of: 0.455176256376397
WordScorePoS
malnutrition0.041835863322702NN

percent table

Label: 0, with a score of: 1

One could also compute the fraction of disease that could be avoided if one eliminated both risk factors

Label: 3, with a score of: 0.813272007973369
WordScorePoS
disease0.215415047323213NN
avoid0VB
eliminate0VB
risk0.0703902516159815NN

Label: 6, with a score of: 0.377733779486492
WordScorePoS
disease0.103230094596636NN
avoid0VB
eliminate0.0295155485671997VB
risk0NN

In the case of Ghana eliminating both indoor air pollution and malnutrition would reduce ALRI by nearly percent

Label: 6, with a score of: 0.489573962189274
WordScorePoS
eliminate0.0295155485671997VB
air0NN
pollution0.0590310971343993NN
malnutrition0.041835863322702NN
reduce0.00936547854413134VB

Label: 14, with a score of: 0.429947184682959
WordScorePoS
eliminate0.0229784274580034VB
air0.0271683202880942NN
pollution0.0689352823740101NN
malnutrition0NN
reduce0.0036456034155327VB

Label: 12, with a score of: 0.354366399542527
WordScorePoS
eliminate0VB
air0.0554128417527413NN
pollution0.0234335422829798NN
malnutrition0NN
reduce0.022306853314744VB

Label: 1, with a score of: 0.315696302755844
WordScorePoS
eliminate0VB
air0NN
pollution0NN
malnutrition0.0736315832425121NN
reduce0.0164833460638534VB

Notice that the sum of AFs calculated for individual risk factors can be more than percent and can differ considerably from the AF calculated for the risk factors jointly

Label: 0, with a score of: 1

This result is common as shown in Chatterjee and Hartge

Label: 6, with a score of: 0.636944172695594
WordScorePoS
result0.0683326727248364NN
common0JJ

Label: 3, with a score of: 0.573694852517335
WordScorePoS
result0NN
common0.0615471563780609JJ

Label: 11, with a score of: 0.514952752263971
WordScorePoS
result0NN
common0.055245183797332JJ

This study controls for risk factors jointly for example environmental health risks and malnutrition but allows malnutrition to be reduced only to the level that would be present without diarrheal infections

Label: 3, with a score of: 0.667051574573666
WordScorePoS
study0NN
control0.020806307400253NN
risk0.0703902516159815NN
jointly0RB
environmental0JJ
health0.191387734041787NN
malnutrition0NN
reduce0.01675146888405VB
level0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.521571702267053
WordScorePoS
study0NN
control0.0614198493690006NN
risk0.0519476926891779NN
jointly0RB
environmental0.0442083771593746JJ
health0NN
malnutrition0.0736315832425121NN
reduce0.0164833460638534VB
level0.0113874611101829NN
infection0NN

Label: 11, with a score of: 0.311884957732985
WordScorePoS
study0NN
control0NN
risk0.0631828116343571NN
jointly0RB
environmental0.0537696560159885JJ
health0.0229054731708393NN
malnutrition0NN
reduce0.0200483235258943VB
level0.00692515656684925NN
infection0NN

It answers this question by how much would disease for example ALRI be reduced if there were no environmental health risk for example indoor air pollution and if the burden of ALRIs that was caused by lack of water sanitation and hygiene and was not related to indoor air pollution were avoided

Label: 6, with a score of: 0.790133679545063
WordScorePoS
disease0.103230094596636NN
reduce0.00936547854413134VB
environmental0JJ
health0NN
risk0NN
air0NN
pollution0.0590310971343993NN
burden0NN
cause0NN
lack0.0214003646985842NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
related0.0524959536790166JJ
avoid0VB

Label: 3, with a score of: 0.383404154631394
WordScorePoS
disease0.215415047323213NN
reduce0.01675146888405VB
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
air0.020806307400253NN
pollution0.0175975629039954NN
burden0NN
cause0NN
lack0NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
related0.0125195145191824JJ
avoid0VB

Label: 12, with a score of: 0.278165470072478
WordScorePoS
disease0NN
reduce0.022306853314744VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
burden0NN
cause0NN
lack0NN
water0.186896403054502NN
sanitation0NN
hygiene0NN
related0.00833571598658786JJ
avoid0VB

A problem one faces is the difficulty in saying what fraction of the resulting AF is attributable to each risk factor

Label: 3, with a score of: 0.484890424834136
WordScorePoS
difficulty0NN
result0NN
risk0.0703902516159815NN

The new including malnutrition costs amount to million or US million which is equivalent to

Label: 1, with a score of: 0.568814048400731
WordScorePoS
include0VB
malnutrition0.0736315832425121NN
cost0NN
amount0.0614198493690006NN
equivalent0JJ

Label: 16, with a score of: 0.462420891711186
WordScorePoS
include0VB
malnutrition0NN
cost0.0548954478802642NN
amount0.0548954478802642NN
equivalent0JJ

Label: 12, with a score of: 0.396487867967864
WordScorePoS
include0VB
malnutrition0NN
cost0.0277064208763707NN
amount0NN
equivalent0.0664302389559493JJ

Label: 2, with a score of: 0.300884841404355
WordScorePoS
include0VB
malnutrition0.0357189919948307NN
cost0NN
amount0NN
equivalent0.0357189919948307JJ

percent of Ghana GDP percent increase over previous estimates

Label: 14, with a score of: 0.523317555744108
WordScorePoS
gdp0.0531983120572613NN
increase0.00470029406779661NN
previous0JJ
estimate0.0195550357485727NN

Label: 3, with a score of: 0.502022126519921
WordScorePoS
gdp0NN
increase0.0143984997539974NN
previous0JJ
estimate0.059903311017139NN

In Pakistan the earlier estimated costs of environmental factors amount to PRs billion US

Label: 16, with a score of: 0.448763529260205
WordScorePoS
estimate0NN
cost0.0548954478802642NN
environmental0JJ
amount0.0548954478802642NN

Label: 12, with a score of: 0.439300742135295
WordScorePoS
estimate0.0199423462679015NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
amount0NN

Label: 1, with a score of: 0.4317488749683
WordScorePoS
estimate0NN
cost0NN
environmental0.0442083771593746JJ
amount0.0614198493690006NN

Label: 10, with a score of: 0.367316137500473
WordScorePoS
estimate0NN
cost0.0660824365173543NN
environmental0.0237821918091848JJ
amount0NN

Label: 3, with a score of: 0.329895597948612
WordScorePoS
estimate0.059903311017139NN
cost0NN
environmental0JJ
amount0.020806307400253NN

billion which is equivalent to

Label: 12, with a score of: 0.73736624946011
WordScorePoS
equivalent0.0664302389559493JJ

Label: 8, with a score of: 0.546898518605942
WordScorePoS
equivalent0.049270765107907JJ

Label: 2, with a score of: 0.396475755253403
WordScorePoS
equivalent0.0357189919948307JJ

percent of GDP

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

The new including malnutrition costs raise that figure to

Label: 9, with a score of: 0.497850991675111
WordScorePoS
include0VB
malnutrition0NN
cost0NN
raise0.0368585655748969NN
figure0.0602029956716497NN

Label: 13, with a score of: 0.487933489432267
WordScorePoS
include0VB
malnutrition0NN
cost0.0279982034978914NN
raise0.0671298309154199NN
figure0NN

Label: 1, with a score of: 0.377673264937281
WordScorePoS
include0VB
malnutrition0.0736315832425121NN
cost0NN
raise0NN
figure0NN

Label: 10, with a score of: 0.338951961311492
WordScorePoS
include0VB
malnutrition0NN
cost0.0660824365173543NN
raise0NN
figure0NN

Label: 12, with a score of: 0.312480542145259
WordScorePoS
include0VB
malnutrition0NN
cost0.0277064208763707NN
raise0.0332151194779746NN
figure0NN

percent of the country GDP percent increase over previous estimates

Label: 14, with a score of: 0.523317555744108
WordScorePoS
country0NN
gdp0.0531983120572613NN
increase0.00470029406779661NN
previous0JJ
estimate0.0195550357485727NN

Label: 3, with a score of: 0.502022126519921
WordScorePoS
country0NN
gdp0NN
increase0.0143984997539974NN
previous0JJ
estimate0.059903311017139NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL The lower cost in Pakistan results from its lower child mortality rate and its lower birth rate which gives lower share of children under five in the total population

Label: 3, with a score of: 0.720932768708878
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
cost0NN
result0NN
mortality0.276962203701274NN
rate0.0433561464459019NN
birth0.0748292956291867NN
share0NN
total0NN
population0NN

Label: 16, with a score of: 0.315786202774994
WordScorePoS
environmental0JJ
health0NN
child0.0603953832457135NN
cost0.0548954478802642NN
result0NN
mortality0NN
rate0.0571955184484387NN
birth0.0658099748168827NN
share0NN
total0NN
population0NN

Label: 10, with a score of: 0.312584393213395
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
child0.0242343960710022NN
cost0.0660824365173543NN
result0NN
mortality0.0488696285210061NN
rate0.0172128079963482NN
birth0.0396106020715138NN
share0NN
total0NN
population0.0860640399817412NN

Impact on Education Affecting School Performance and Future Work Productivity Chapter discussed another indirect effect of the link between repeated infections in early childhood and malnutrition the impairment of cognitive development resulting in poor school performance and subsequently in loss of lifetime earnings

Label: 4, with a score of: 0.718617823398803
WordScorePoS
impact0NN
education0.244244978014045NN
affect0.0125233923809486VB
school0.208127520578185NN
performance0NN
future0NN
productivity0NN
effect0NN
infection0NN
childhood0.0815069365350084NN
malnutrition0NN
development0.0279277626235394NN
result0NN
poor0JJ
loss0NN

Label: 1, with a score of: 0.258787557317071
WordScorePoS
impact0NN
education0.0225244866060403NN
affect0.0184786920895884VB
school0NN
performance0NN
future0NN
productivity0NN
effect0NN
infection0NN
childhood0NN
malnutrition0.0736315832425121NN
development0.0164833460638534NN
result0NN
poor0.150659516460257JJ
loss0NN

Many studies have documented the effect of early childhood malnutrition on cognitive function school enrollment grade repetition school dropout rates grade attainment and test scores among school age children see appendix

Label: 4, with a score of: 0.760580973231832
WordScorePoS
study0NN
document0NN
effect0NN
childhood0.0815069365350084NN
malnutrition0NN
function0NN
school0.208127520578185NN
rate0.0216847879059514NN
age0.0255262687343935NN
child0.076326555629389NN

The majority of these studies use stunting low height for age as measure of malnutrition which is considered an indicator of chronic nutritional deficit

Label: 1, with a score of: 0.774848410053695
WordScorePoS
majority0.0736315832425121NN
study0NN
stunt0NN
height0.120266261535276NN
age0.112994637345193NN
measure0.103895385378356NN
malnutrition0.0736315832425121NN
chronic0JJ
nutritional0JJ

Label: 2, with a score of: 0.533296112683971
WordScorePoS
majority0.0357189919948307NN
study0NN
stunt0.11668334276823NN
height0NN
age0.0365427838531249NN
measure0.0504000902222448NN
malnutrition0.0357189919948307NN
chronic0JJ
nutritional0.0583416713841148JJ

Here for the first time this study attempts to estimate the loss in lifetime earnings from stunting in Ghana and Pakistan and the share of this loss that could be avoided if children were not exposed to repeated diarrheal infections in early childhood

Label: 3, with a score of: 0.538688523068177
WordScorePoS
time0.0127591822694525NN
study0NN
estimate0.059903311017139NN
loss0NN
stunt0NN
share0NN
avoid0VB
child0.10682408961305NN
infection0.122222546933424NN
childhood0NN

Label: 2, with a score of: 0.403747304489376
WordScorePoS
time0.0182713919265625NN
study0NN
estimate0NN
loss0NN
stunt0.11668334276823NN
share0.0365427838531249NN
avoid0VB
child0.0546336178945768NN
infection0NN
childhood0NN

Effects of malnutrition on education outcomes applied to Ghana and Pakistan for estimation of the cost of malnutrition are presented in table

Label: 4, with a score of: 0.690153605535205
WordScorePoS
effect0NN
malnutrition0NN
education0.244244978014045NN
outcome0.0416255041156371NN
cost0NN

stratified by height for age deficit

Label: 1, with a score of: 0.910347366321829
WordScorePoS
height0.120266261535276NN
age0.112994637345193NN

Label: 3, with a score of: 0.348566846042973
WordScorePoS
height0NN
age0.0893142758861673NN

The magnitude of these effects is based on the review of longitudinal studies

Label: 15, with a score of: 0.468604948898729
WordScorePoS
effect0NN
base0.0190167691930804NN
review0NN
study0.0517339898971162NN

Label: 5, with a score of: 0.456122863992752
WordScorePoS
effect0NN
base0NN
review0.0688661930304451NN
study0NN

Effects analyzed include those on grade attainment school achievement learning productivity in terms of grade equivalents delayed primary school enrollment and grade repetition

Label: 4, with a score of: 0.842879250902991
WordScorePoS
effect0NN
include0VB
school0.208127520578185NN
achievement0NN
learn0.244520809605025VB
productivity0NN
term0NN
equivalent0JJ
primary0.108423939529757JJ

Label: 17, with a score of: 0.196970011343983
WordScorePoS
effect0NN
include0VB
school0NN
achievement0.0299586785922821NN
learn0VB
productivity0NN
term0.149793392961411NN
equivalent0JJ
primary0JJ

Label: 5, with a score of: 0.310401704362639
WordScorePoS
effect0NN
include0VB
school0.0931221694711702NN
achievement0NN
learn0VB
productivity0NN
term0NN
equivalent0JJ
primary0.0970239057629001JJ

The latter two effects result in delayed labor force entry

Label: 2, with a score of: 0.575321195804499
WordScorePoS
effect0.0440683498519077NN
result0NN
force0.0297950283197006NN

Label: 6, with a score of: 0.532242580257203
WordScorePoS
effect0NN
result0.0683326727248364NN
force0NN

Psacharopoulos and Patrinos provide review of studies of returns to investment in education

Label: 4, with a score of: 0.665264293523084
WordScorePoS
provide0.0100202166857628VB
review0NN
study0NN
return0NN
investment0NN
education0.244244978014045NN

Label: 16, with a score of: 0.368489174677035
WordScorePoS
provide0.013214597504793VB
review0NN
study0NN
return0.107490825192354NN
investment0NN
education0.0201317944152378NN

Label: 5, with a score of: 0.343537188851631
WordScorePoS
provide0.0112083245137075VB
review0.0688661930304451NN
study0NN
return0NN
investment0NN
education0.0512260062633133NN

Label: 17, with a score of: 0.312927083317484
WordScorePoS
provide0.00601568197638796VB
review0.036961556179878NN
study0NN
return0NN
investment0.0766240489430275NN
education0NN

Private returns are estimated on the basis of private cost of schooling and lifetime income

Label: 10, with a score of: 0.496552472043033
WordScorePoS
private0JJ
return0NN
estimate0NN
basis0NN
cost0.0660824365173543NN
schooling0NN
income0.166475342664294NN

Label: 17, with a score of: 0.526689513125193
WordScorePoS
private0.0898760357768464JJ
return0NN
estimate0NN
basis0.048933054487825NN
cost0NN
schooling0NN
income0.017987180284335NN

Label: 9, with a score of: 0.440906660405888
WordScorePoS
private0.0368585655748969JJ
return0NN
estimate0.0221298700466866NN
basis0NN
cost0NN
schooling0NN
income0.110649350233433NN

Label: 16, with a score of: 0.346723750131281
WordScorePoS
private0JJ
return0.107490825192354NN
estimate0NN
basis0NN
cost0.0548954478802642NN
schooling0NN
income0NN

Social returns include social cost of providing TABLE

Label: 10, with a score of: 0.587112350995611
WordScorePoS
social0.101310366625194JJ
return0NN
include0VB
cost0.0660824365173543NN
provide0VB

Label: 1, with a score of: 0.55839388717982
WordScorePoS
social0.112994637345193JJ
return0NN
include0VB
cost0NN
provide0.0295703421524739VB

Label: 16, with a score of: 0.383685239183049
WordScorePoS
social0JJ
return0.107490825192354NN
include0VB
cost0.0548954478802642NN
provide0.013214597504793VB

Effects of Malnutrition on Education Effects of Stunting Loss in grade attainment school years Loss in school achievement grade equivalents Total grade equivalent losses grade attainment and achievement Delayed enrollment years Grade repetition percentage of students with one repetition Delayed labor force entry years caused by delayed enrollment and grade repetition − to − Height for age Score − to − Lower than

Label: 4, with a score of: 0.584988024489633
WordScorePoS
effect0NN
malnutrition0NN
education0.244244978014045NN
stunt0NN
loss0NN
school0.208127520578185NN
achievement0NN
equivalent0JJ
total0NN
percentage0NN
force0NN
cause0NN
height0NN
age0.0255262687343935NN

Sources Compiled by World Bank team on the basis of review of longitudinal studies

Label: 17, with a score of: 0.612113332834047
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN
basis0.048933054487825NN
review0.036961556179878NN
study0NN

Label: 2, with a score of: 0.504298032245521
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN
basis0NN
review0NN
study0NN

For more details see appendix B

Label: 0, with a score of: 1

Note Stunting is defined as height for age score lower than −

Label: 1, with a score of: 0.787225726538988
WordScorePoS
stunt0NN
height0.120266261535276NN
age0.112994637345193NN

Label: 2, with a score of: 0.517118597386794
WordScorePoS
stunt0.11668334276823NN
height0NN
age0.0365427838531249NN

Label: 3, with a score of: 0.301424268114569
WordScorePoS
stunt0NN
height0NN
age0.0893142758861673NN

ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL schooling which is most often significantly higher than private cost because of subsidized provision of education

Label: 3, with a score of: 0.484091583732507
WordScorePoS
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
burden0NN
cost0NN
country0NN
level0NN
schooling0.0407408489778079NN
significantly0RB
private0JJ
provision0.0249430985430622NN
education0.0152605842304358NN

Label: 4, with a score of: 0.433273076834462
WordScorePoS
estimate0.0299609328954485NN
environmental0JJ
health0NN
burden0NN
cost0NN
country0NN
level0.0231525547935232NN
schooling0NN
significantly0RB
private0JJ
provision0NN
education0.244244978014045NN

Label: 16, with a score of: 0.374175759226517
WordScorePoS
estimate0NN
environmental0JJ
health0NN
burden0NN
cost0.0548954478802642NN
country0NN
level0.0610668815653026NN
schooling0NN
significantly0RB
private0JJ
provision0.0658099748168827NN
education0.0201317944152378NN

Label: 5, with a score of: 0.345667564932937
WordScorePoS
estimate0NN
environmental0JJ
health0.0571058915334038NN
burden0NN
cost0NN
country0NN
level0.0172651853471334NN
schooling0NN
significantly0RB
private0.0558185411034276JJ
provision0.0558185411034276NN
education0.0512260062633133NN

Label: 10, with a score of: 0.303928599359613
WordScorePoS
estimate0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN
cost0.0660824365173543NN
country0NN
level0NN
schooling0NN
significantly0RB
private0JJ
provision0NN
education0.0121171980355011NN

Social returns are therefore lower than private returns to investment in education

Label: 4, with a score of: 0.503240531425505
WordScorePoS
social0JJ
return0NN
private0JJ
investment0NN
education0.244244978014045NN

Label: 16, with a score of: 0.484425988482768
WordScorePoS
social0JJ
return0.107490825192354NN
private0JJ
investment0NN
education0.0201317944152378NN

Label: 1, with a score of: 0.356827028527351
WordScorePoS
social0.112994637345193JJ
return0NN
private0JJ
investment0.0376648791150643NN
education0.0225244866060403NN

Label: 17, with a score of: 0.343055533006712
WordScorePoS
social0JJ
return0NN
private0.0898760357768464JJ
investment0.0766240489430275NN
education0NN

Returns to one additional year of schooling are calculated estimates from Psacharopoulos and Patrinos

Label: 16, with a score of: 0.647948794237043
WordScorePoS
return0.107490825192354NN
additional0JJ
schooling0NN
estimate0NN

Label: 3, with a score of: 0.606677472231041
WordScorePoS
return0NN
additional0JJ
schooling0.0407408489778079NN
estimate0.059903311017139NN

On average the return to one additional year of schooling is

Label: 13, with a score of: 0.647448000338197
WordScorePoS
average0.1656430212089NN
return0NN
additional0JJ
schooling0NN

Label: 10, with a score of: 0.573049375076768
WordScorePoS
average0.146608885563018NN
return0NN
additional0JJ
schooling0NN

Label: 16, with a score of: 0.420148819537186
WordScorePoS
average0NN
return0.107490825192354NN
additional0JJ
schooling0NN

percent

Label: 0, with a score of: 1

The rate of return is

Label: 16, with a score of: 0.87586706941985
WordScorePoS
rate0.0571955184484387NN
return0.107490825192354NN

Label: 1, with a score of: 0.340341591980302
WordScorePoS
rate0.0639932865717261NN
return0NN

percent in Sub Saharan Africa and

Label: 1, with a score of: 0.57938972469668
WordScorePoS
saharan0.0442083771593746JJ
africa0IN

Label: 5, with a score of: 0.439223058077786
WordScorePoS
saharan0.0335134328085675JJ
africa0IN

percent in Asia

Label: 0, with a score of: 1

These rates of return are applied to Ghana and Pakistan respectively to estimate the cost of impacts of malnutrition on education outcomes

Label: 4, with a score of: 0.614666291241338
WordScorePoS
rate0.0216847879059514NN
return0NN
estimate0.0299609328954485NN
cost0NN
impact0NN
malnutrition0NN
education0.244244978014045NN
outcome0.0416255041156371NN

Label: 16, with a score of: 0.48863413962222
WordScorePoS
rate0.0571955184484387NN
return0.107490825192354NN
estimate0NN
cost0.0548954478802642NN
impact0.0285977592242194NN
malnutrition0NN
education0.0201317944152378NN
outcome0NN

To estimate the lifetime income for children in Ghana and Pakistan the analysis considered existing income differentials between children in different nutritional status from not malnourished to severely malnourished

Label: 10, with a score of: 0.626121403064155
WordScorePoS
estimate0NN
income0.166475342664294NN
child0.0242343960710022NN
exist0VB
differential0.0488696285210061JJ
nutritional0JJ
status0.0488696285210061NN
severely0RB

Label: 2, with a score of: 0.387155801286459
WordScorePoS
estimate0NN
income0.0643370113878709NN
child0.0546336178945768NN
exist0VB
differential0JJ
nutritional0.0583416713841148JJ
status0NN
severely0RB

This differentiation is important because malnourished children live disproportionately in poorer households given that poverty is correlated with lower socioeconomic status such as lower educational attainment of parents it is in turn correlated with lower educational attainment of their children

Label: 1, with a score of: 0.630857328041306
WordScorePoS
child0.0450489732120807NN
live0.0739258553811849VB
household0NN
poverty0.269969049497485NN
status0NN
educational0JJ

Malnourished children are more likely to come from lower income households than are children who are not malnourished

Label: 10, with a score of: 0.503662215707525
WordScorePoS
child0.0242343960710022NN
income0.166475342664294NN
household0.0330412182586772NN

Label: 3, with a score of: 0.433922866818275
WordScorePoS
child0.10682408961305NN
income0NN
household0NN

Label: 2, with a score of: 0.413107179532269
WordScorePoS
child0.0546336178945768NN
income0.0643370113878709NN
household0.0297950283197006NN

Label: 4, with a score of: 0.31004090887214
WordScorePoS
child0.076326555629389NN
income0NN
household0NN

Therefore the income potential of malnourished children is affected not only by the action of malnutrition on educational performance but also by the socioeconomic status of the household they grew up in see appendix for methodology on calculations

Label: 10, with a score of: 0.627663175429931
WordScorePoS
income0.166475342664294NN
potential0NN
child0.0242343960710022NN
affect0VB
action0.0145231653596925NN
malnutrition0NN
educational0JJ
performance0.064698038783335NN
status0.0488696285210061NN
household0.0330412182586772NN
grow0.0405241466500776VB

Label: 1, with a score of: 0.333318290031503
WordScorePoS
income0.0442083771593746NN
potential0NN
child0.0450489732120807NN
affect0.0184786920895884VB
action0.0269969049497485NN
malnutrition0.0736315832425121NN
educational0JJ
performance0NN
status0NN
household0NN
grow0VB

Label: 2, with a score of: 0.324346455907281
WordScorePoS
income0.0643370113878709NN
potential0NN
child0.0546336178945768NN
affect0VB
action0NN
malnutrition0.0357189919948307NN
educational0JJ
performance0NN
status0NN
household0.0297950283197006NN
grow0.0182713919265625VB

Label: 9, with a score of: 0.316325850652194
WordScorePoS
income0.110649350233433NN
potential0.0454743001434393NN
child0NN
affect0.00925008066007716VB
action0.0135141354781442NN
malnutrition0NN
educational0JJ
performance0NN
status0NN
household0NN
grow0.0188543197850406VB

About children are born annually in Ghana

Label: 3, with a score of: 0.80827766724665
WordScorePoS
child0.10682408961305NN
bear0.0814816979556159NN
annually0RB

Label: 4, with a score of: 0.327621636751858
WordScorePoS
child0.076326555629389NN
bear0NN
annually0RB

Thirty five percent of these children are moderately or severely stunted by the time they reach one to two years of age and an additional percent are mildly stunted height for age score to

Label: 2, with a score of: 0.596856679670656
WordScorePoS
child0.0546336178945768NN
moderately0RB
severely0RB
stunt0.11668334276823NN
time0.0182713919265625NN
reach0NN
age0.0365427838531249NN
additional0.0440683498519077JJ
height0NN

Label: 1, with a score of: 0.551579080525847
WordScorePoS
child0.0450489732120807NN
moderately0RB
severely0RB
stunt0NN
time0NN
reach0NN
age0.112994637345193NN
additional0JJ
height0.120266261535276NN

Label: 3, with a score of: 0.420356524206225
WordScorePoS
child0.10682408961305NN
moderately0RB
severely0RB
stunt0NN
time0.0127591822694525NN
reach0NN
age0.0893142758861673NN
additional0JJ
height0NN

On the basis of these prevalence rates the effect of stunting on educational outcomes income losses from loss in education and labor force participation rate of percent the annual cost of stunting that is attributable to early childhood diarrheal infections is estimated to be about

Label: 4, with a score of: 0.467095804279058
WordScorePoS
basis0NN
prevalence0NN
rate0.0216847879059514NN
effect0NN
stunt0NN
educational0JJ
outcome0.0416255041156371NN
income0NN
loss0NN
education0.244244978014045NN
force0NN
participation0NN
cost0NN
childhood0.0815069365350084NN
infection0NN
estimate0.0299609328954485NN

Label: 10, with a score of: 0.330831649311197
WordScorePoS
basis0NN
prevalence0NN
rate0.0172128079963482NN
effect0NN
stunt0NN
educational0JJ
outcome0.0330412182586772NN
income0.166475342664294NN
loss0NN
education0.0121171980355011NN
force0NN
participation0NN
cost0.0660824365173543NN
childhood0NN
infection0NN
estimate0NN

Label: 2, with a score of: 0.426717239098297
WordScorePoS
basis0NN
prevalence0NN
rate0.0155217067874935NN
effect0.0440683498519077NN
stunt0.11668334276823NN
educational0JJ
outcome0NN
income0.0643370113878709NN
loss0NN
education0NN
force0.0297950283197006NN
participation0NN
cost0NN
childhood0NN
infection0NN
estimate0NN

Label: 3, with a score of: 0.366341823315328
WordScorePoS
basis0NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
effect0NN
stunt0NN
educational0JJ
outcome0NN
income0NN
loss0NN
education0.0152605842304358NN
force0.020806307400253NN
participation0NN
cost0NN
childhood0NN
infection0.122222546933424NN
estimate0.059903311017139NN

percent of GDP

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

million children are born annually in Pakistan

Label: 3, with a score of: 0.80827766724665
WordScorePoS
child0.10682408961305NN
bear0.0814816979556159NN
annually0RB

Label: 4, with a score of: 0.327621636751858
WordScorePoS
child0.076326555629389NN
bear0NN
annually0RB

According to the Pakistan National Nutrition Survey PIDE prevalence of moderate and severe stunting in children under five years was and percent respectively

Label: 2, with a score of: 0.828055803078189
WordScorePoS
national0.00399807039435538JJ
nutrition0.175025014152344NN
survey0NN
prevalence0NN
stunt0.11668334276823NN
child0.0546336178945768NN

Label: 3, with a score of: 0.361978947230275
WordScorePoS
national0.00558382296134999JJ
nutrition0NN
survey0NN
prevalence0.0407408489778079NN
stunt0NN
child0.10682408961305NN

No prevalence rate is reported for mild stunting

Label: 2, with a score of: 0.647133241670705
WordScorePoS
prevalence0NN
rate0.0155217067874935NN
report0NN
stunt0.11668334276823NN

Label: 3, with a score of: 0.562282355510588
WordScorePoS
prevalence0.0407408489778079NN
rate0.0433561464459019NN
report0.0307735781890304NN
stunt0NN

Label: 1, with a score of: 0.313242066951979
WordScorePoS
prevalence0NN
rate0.0639932865717261NN
report0NN
stunt0NN

A rate of percent is therefore assumed in accordance with cross country comparison

Label: 16, with a score of: 0.512423282981677
WordScorePoS
rate0.0571955184484387NN
accordance0.0241291244414115NN
country0NN

On the basis of these prevalence rates the effect of stunting on educational outcomes income losses from educational losses and labor force participation rate of percent the annual cost of stunting attributable to early childhood diarrheal infections is estimated to be about

Label: 10, with a score of: 0.363247873912668
WordScorePoS
basis0NN
prevalence0NN
rate0.0172128079963482NN
effect0NN
stunt0NN
educational0JJ
outcome0.0330412182586772NN
income0.166475342664294NN
loss0NN
force0NN
participation0NN
cost0.0660824365173543NN
childhood0NN
infection0NN
estimate0NN

Label: 2, with a score of: 0.487451353911344
WordScorePoS
basis0NN
prevalence0NN
rate0.0155217067874935NN
effect0.0440683498519077NN
stunt0.11668334276823NN
educational0JJ
outcome0NN
income0.0643370113878709NN
loss0NN
force0.0297950283197006NN
participation0NN
cost0NN
childhood0NN
infection0NN
estimate0NN

Label: 3, with a score of: 0.400006382964962
WordScorePoS
basis0NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
effect0NN
stunt0NN
educational0JJ
outcome0NN
income0NN
loss0NN
force0.020806307400253NN
participation0NN
cost0NN
childhood0NN
infection0.122222546933424NN
estimate0.059903311017139NN

percent of GDP see appendix for methodology on calculations

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

Conclusion Malnutrition mediated effects of environmental risk factors are estimated to have considerable social and economic burden in Ghana and Pakistan see figure

Label: 8, with a score of: 0.328760391517463
WordScorePoS
conclusion0NN
malnutrition0NN
effect0NN
environmental0.0295821503613099JJ
risk0NN
estimate0NN
social0.0504071033101074JJ
economic0.128463821595706JJ
burden0NN
figure0NN

Label: 1, with a score of: 0.597378106704205
WordScorePoS
conclusion0NN
malnutrition0.0736315832425121NN
effect0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
estimate0NN
social0.112994637345193JJ
economic0.0959899298575892JJ
burden0NN
figure0NN

Label: 10, with a score of: 0.360171301702138
WordScorePoS
conclusion0NN
malnutrition0NN
effect0NN
environmental0.0237821918091848JJ
risk0NN
estimate0NN
social0.101310366625194JJ
economic0.103276847978089JJ
burden0NN
figure0NN

Label: 11, with a score of: 0.318078615604931
WordScorePoS
conclusion0NN
malnutrition0NN
effect0NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN
estimate0NN
social0.0458109463416786JJ
economic0.0389167984372011JJ
burden0NN
figure0NN

Label: 9, with a score of: 0.316730097182059
WordScorePoS
conclusion0NN
malnutrition0NN
effect0.0454743001434393NN
environmental0.0221298700466866JJ
risk0NN
estimate0.0221298700466866NN
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE

Label: 3, with a score of: 0.738034958017592
WordScorePoS
environmental0JJ
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child0.10682408961305NN
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Final Results of Ghana and Pakistan Case Studies

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WordScorePoS
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percentage of GDP

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Label: 14, with a score of: 0.673784531362605
WordScorePoS
percentage0NN
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direct effect only direct effect indirect malnutrition mediated effect Ghana direct indirect education Pakistan Source Compiled by World Bank team

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WordScorePoS
direct0JJ
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WordScorePoS
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and table

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For Ghana the cost of total health effects including malnutrition amounts to million US million

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WordScorePoS
cost0NN
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When longer term effects on education and income are included this figure may reach as high as million US billion equivalent to

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WordScorePoS
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percent of GDP

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Similarly for Pakistan the cost of total health effects from environmental risk factors amounts to PRs billion US

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WordScorePoS
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Label: 12, with a score of: 0.359370195647947
WordScorePoS
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And with longer term effects on education and income this figure may reach as high as PRs billion US

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billion or equivalent to

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WordScorePoS
equivalent0.0664302389559493JJ

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equivalent0.049270765107907JJ

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percent of the country GDP

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Put in perspective the costs of these total effects are nearly three times higher than the cost of the effect of environmental risk factors only excluding malnutrition

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WordScorePoS
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perspective0NN
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malnutrition0.0357189919948307NN

Label: 12, with a score of: 0.377285831624587
WordScorePoS
perspective0NN
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The issue of temporality is important to recognize while analyzing these results

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These figures indicate that the health benefits from reducing environmental risks are high even if such benefits will accrue far into the future

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With the focus on children under five years of age environmental health interventions implemented today to avoid deaths and illness and to increase education attainment will generate returns only few years from now

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WordScorePoS
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Label: 4, with a score of: 0.369437142576925
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Conventional decision making in developing countries often lacks this longer term perspective when policy makers choose appropriate interventions to benefit child health

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WordScorePoS
decision0NN
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Label: 17, with a score of: 0.360095925544302
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Label: 10, with a score of: 0.407463632502493
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By providing better understanding of the links between environmental risks the causes and child health ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL TABLE

Label: 3, with a score of: 0.703543749368535
WordScorePoS
provide0.0100171139310145VB
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Label: 11, with a score of: 0.310305400207855
WordScorePoS
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Annual Cost of Direct and Indirect Impact of Environmental Risk Factors in Ghana Annual Deaths Cost million Cost US million Cost of GDP Estimation excluding malnutrition mediated effects Mortality effects

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WordScorePoS
cost0NN
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Estimation including malnutrition mediated effects Mortality effects

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mortality0.276962203701274NN

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Education effects

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Total effects

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Label: 7, with a score of: 0.421040118053001
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Label: 12, with a score of: 0.373200704009363
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Annual Deaths Pakistan Cost Cost PRs US billion million Cost of GDP

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WordScorePoS
death0.193573191943949NN
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Label: 16, with a score of: 0.562944189450848
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Source Compiled by World Bank team

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Label: 6, with a score of: 0.426402661922482
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Note Ï­ Ghanaian new cedi

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the effect as well as the timing of these effects this study hopes to influence the way that governments choose between short term and long term interventions

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Given the importance of time in these results the methodology relating to discounting becomes very relevant

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In this report the calculations used percent discount rate which is consistent with the rate used in WHO burden of disease calculations

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The purpose of discounting is to recognize general preference for benefits that happen earlier

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Different discount rates are used in different situations

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When one looks at public sector decisions social discount rate is preferred to private one that is the rate commercial bank would apply on loan

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Pearce and Ulph report an estimated social rate of return on investments for industrial countries between and percent

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In appendix sensitivity analysis applied to Ghana varies the discount rate from percent to percent more conservative discount rate to show how the results would vary

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In the case of Ghana percent discount rate would reduce the total cost estimates from

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percent to

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percent of GDP and in Pakistan it would reduce them from

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percent to

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percent of GDP

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The considerable difference is explained by the fact that large part of the benefits from interventions for example higher incomes owing to education will happen several years from now

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Box

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provides guidelines for policy makers in interpreting the results

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Next Steps For policy makers to prioritize among various environmental health interventions further analyses and studies are required to guide their decisions along two ENVIRONMENTAL HEALTH AND CHILD SURVIVAL BOX

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How Policy makers Should Interpret These Results Using Ghana and Pakistan as examples this study estimates the annual costs associated with environmental risks for children under five years of age

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These estimations carried out at national level provide sense of the magnitude of these costs about percent of country GDP to policymakers and highlight the urgent need to position environmental health at the center of all child survival strategies

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Label: 16, with a score of: 0.349648139620132
WordScorePoS
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These figures help carry the message that environmental risks to child health are considerable and that such risks impose significant economic burden

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WordScorePoS
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Label: 11, with a score of: 0.350503759574954
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Label: 10, with a score of: 0.302341072268163
WordScorePoS
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That being said these figures do not help policy makers prioritize in terms of costs and capacity to implement among the various types of environmental health interventions that are available to them

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WordScorePoS
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Label: 10, with a score of: 0.492363617809119
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Label: 12, with a score of: 0.32969995810404
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For example if policy makers in Pakistan choose to address diarrhea in children should they invest in sanitation in hygiene promotion in increased water availability or in some combination of these interventions

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WordScorePoS
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Label: 12, with a score of: 0.21681932601253
WordScorePoS
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These choices as well as the underlying framework that helps determine their priority are important because they help policy makers translate the environmental health agenda into concrete programs and actions addressing environmental health

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Label: 12, with a score of: 0.493831546491683
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Label: 10, with a score of: 0.452371713879451
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major paths one relating to costs and benefits of specific interventions which has implications for budgetary and resource allocation decisions and the second relating to institutional capacity which helps ascertain the required roles and responsibilities of various agencies in implementing these interventions

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These analyses and studies need to be carried out separately for specific countries because the priorities may differ according to the country current level of development its population health profile and the relative exposures to different disease and its capacity to implement specific interventions

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Label: 12, with a score of: 0.395533392358782
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In terms of economic approaches two main methods are typically used costeffectiveness analysis and cost benefit analysis

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Label: 8, with a score of: 0.34531413647726
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Label: 10, with a score of: 0.561716559832062
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Label: 12, with a score of: 0.336700381804211
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Label: 5, with a score of: 0.301457780968655
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Cost effectiveness analysis allows researchers to compare policy options that provide outcomes measurable with common metric for example per child life saved

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WordScorePoS
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Label: 10, with a score of: 0.416767465444801
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An example would be an assessment of how costs of providing latrines to village compare with costs of providing access to safe drinking water per child life saved

Label: 6, with a score of: 0.825575767217971
WordScorePoS
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Label: 12, with a score of: 0.281884868971557
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Cost benefit analysis in contrast can be applied to compare options that do not necessarily provide outcomes measured using the same metric by reducing the benefits of each option to common numeraire that is by assigning monetary value for the various policy options

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The choice of method used to carry out an economic analysis at country level must be made after examining the availability of relevant data

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WordScorePoS
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Label: 17, with a score of: 0.453302392727777
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Label: 12, with a score of: 0.328245160850033
WordScorePoS
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Label: 16, with a score of: 0.324991114914462
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choice0NN
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For Ghana and Pakistan for example this choice means looking at specific environmental risks identifying possible interventions that would address them and then assessing ESTIMATING THE ENVIRONMENTAL HEALTH BURDEN AND COSTS AT THE COUNTRY LEVEL how much data on the costs and benefits of these interventions are available

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WordScorePoS
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Label: 12, with a score of: 0.434077402241691
WordScorePoS
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Label: 1, with a score of: 0.358505866113994
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In other country level studies cost benefit analyses have helped governments prioritize among available interventions

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WordScorePoS
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Label: 15, with a score of: 0.440778116787364
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In Peru for example the World Bank country environmental analysis reported that drinking water disinfection and handwashing programs had the highest cost benefit ratio for addressing water and sanitation related risks while shifting households from unimproved to improved cookstoves was the best recommendation for interventions to address indoor air pollution World Bank

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WordScorePoS
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Label: 12, with a score of: 0.314680538203281
WordScorePoS
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Policy makers in developing countries also need to choose programs to address environmental risks in accordance with their country institutional capacity to implement these interventions

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Label: 17, with a score of: 0.384023689199241
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Label: 12, with a score of: 0.372570341968059
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Label: 11, with a score of: 0.33850523600379
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Label: 8, with a score of: 0.306820711648365
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The next chapter provides some discussion of the generic roles that national and local governments can play in delivering and managing environmental health interventions

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Label: 10, with a score of: 0.445223288488422
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Label: 12, with a score of: 0.370613682956374
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A more in depth country level institutional analysis is required about what coordination mechanisms exist between ministries and how mandates and budgets are assigned

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Such an institutional analysis would provide guidance on how to better define the roles and responsibilities of different agencies related to addressing public environmental health services and how to correct incentive structures to raise the profile of the environmental health agenda

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WordScorePoS
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Label: 12, with a score of: 0.392978610906364
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Label: 5, with a score of: 0.361457283226026
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Key Messages â–  â–  When malnutrition mediated health effects attributed to environmental risk factors are included the total costs of the environmental health burden are at least percent higher for both Ghana and Pakistan

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When longer term effects of malnutrition partly attributed to environment related infections on education and income are considered the estimated annual cost may be as high as percent of country GDP

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Label: 10, with a score of: 0.433717596467861
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Label: 17, with a score of: 0.255972839509579
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Label: 9, with a score of: 0.354229510967335
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Label: 3, with a score of: 0.320241031050849
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This social and economic burden is not trivial and it highlights the urgent need for policy makers to position environmental health at the center of all child survival strategies

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Label: 3, with a score of: 0.363753237502793
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Label: 10, with a score of: 0.495729686325579
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Label: 1, with a score of: 0.450062806151565
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Next steps to translate these messages into concrete actions include carrying out cost effectiveness and cost benefit analyses at country level to guide decisionmakers in prioritizing among the various available interventions

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An in depth country level institutional analysis would also be needed to assess the capacity of the country to implement these interventions

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Notes Details on the steps in the methodology to calculate these costs for Ghana can be found in appendix D

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These estimates of mortality are based on crude birth rates and population in

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL The Ghana Demographic and Health Survey Ghana Statistical Service does not provide figures for mild underweight to standard deviation

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This figure was therefore calculated from the survey household data

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The original survey data from the nutrition survey PIDE were not readily available for this study so data from the Pakistan Demographic and Health Survey National Institute of Population Studies were used instead

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The survey for was being compiled at the time of this study

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This finding is based on the fact that percent of children weight deficit relative to the international reference population is from infections which is well within the range found in research studies

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Ghanaian currency is denominated in new cedi

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The Ghanaian new cedi U

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dollar exchange rate is from US

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Social cost of providing year of schooling is assumed to be percent to percent of average annual income per person

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By the time the children turn five years old percent of them will have died

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Underfive child mortality rate in Ghana is per live births in according to World Bank

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By the time the children turn five years old percent of them will have died

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Under five child mortality rate in Pakistan is per live births in according to World Bank

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Experiences H E Approaches to Environmental Health THE PRECEDING CHAPTERS PROVIDE EVIDENCE of the importance of environmental health interventions in addressing child health

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Chapter explained the science and the epidemiological underpinnings of the malnutritioninfection cycle and its implications for child health both in utero and in early childhood

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Chapter illustrated how environmental health interventions can appropriately complement and supplement other health and environmental programs that address child health

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Chapter then went on to demonstrate the scale of the environmental health burden in children under five and how that burden is especially important in some subregions with high levels of malnutrition and poor environmental conditions

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Using two country examples Ghana and Pakistan chapter then analyzed the consequent economic burden that these environmental health risks pose

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Clearly the issue of environmental health is critical for child health with the why to what extent and where explained in earlier chapters

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What remains is the how how can these environmental health issues be addressed successfully in developing countries

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This chapter begins with historical review of environmental health outlining the trends in the evolution of environmental health functions in developed countries and highlighting how circumstances have led to the relative neglect of environmental health in the development agenda

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The chapter provides illustrative examples of how different developing countries ENVIRONMENTAL HEALTH AND CHILD SURVIVAL have incorporated environmental health activities within other health nutrition and infrastructure programs

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Identifying some common elements from these examples the chapter then discusses through an institutional lens the roles that national and local governments can play in delivering and managing environmental health interventions

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History of Environmental Health Environmental health is among the earliest public health activities on record

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Through the ages today developed countries have invested in environmental health interventions focusing on sanitation cleanliness and hygiene

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The history of environmental health can be loosely divided into four generations with shifts in the nature and focus of interventions

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Looking at the evolution of environmental health functions over the past few centuries helps to understand the context behind today environmental health agenda in developing countries

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First Generation Origins of Miasma Theory In Classical Greece the source of disease was attributed to bad air or miasmatic odors and interventions sought to fight disease through cleanliness and hygiene Rosen

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air0NN
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Subsequently as the Roman Empire conquered the Mediterranean world it incorporated the ideas of cleanliness and hygiene into infrastructure projects which included the great sewerage system the cloaca maxima baths fresh water supplies health facilities suitable latrines proper ventilation and the organization of the health sector Rosen

Label: 6, with a score of: 0.717985485380656
WordScorePoS
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Label: 12, with a score of: 0.363616525456533
WordScorePoS
world0.00464349782489754NN
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proper0JJ
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Label: 3, with a score of: 0.339001874621686
WordScorePoS
world0.00087176582269799NN
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Label: 9, with a score of: 0.281112916457897
WordScorePoS
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fresh0JJ
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For the English sanitary reformers of the mid th century miasma continued to prevail in explanations of disease transmission

Label: 13, with a score of: 0.719155057533559
WordScorePoS
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Label: 3, with a score of: 0.596756705244096
WordScorePoS
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In however John Snow traced an outbreak of cholera in London to common drinking water source refuting the miasma hypothesis

Label: 6, with a score of: 0.948953816281175
WordScorePoS
snow0NN
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Label: 12, with a score of: 0.215178942710714
WordScorePoS
snow0NN
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The Report of the Royal Sanitary Commission listed essential health services mostly environmental in nature that covered access to improved water and sanitation provision of sewerage system healthiness of dwellings and inspection of food Kotchian WHO

Label: 6, with a score of: 0.703613766275386
WordScorePoS
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Label: 12, with a score of: 0.476534687351443
WordScorePoS
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Label: 2, with a score of: 0.288326439102239
WordScorePoS
report0NN
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Label: 3, with a score of: 0.270616971617045
WordScorePoS
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Second Generation Sanitation Vaccinations Multisectoral Interventions Refuting the dominant theory of miasma Louis Pasteur by the late th century had developed the germ theory that proposes that microorganisms are the cause of many diseases

Label: 6, with a score of: 0.722184806458824
WordScorePoS
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Label: 3, with a score of: 0.463570545653724
WordScorePoS
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Label: 13, with a score of: 0.361644415043541
WordScorePoS
generation0NN
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This theory paved the way for more targeted and cost efficient environmental and public health interventions such as chlorination of water supplies pasteurization of milk see box

Label: 6, with a score of: 0.645320231766072
WordScorePoS
target0NN
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Label: 12, with a score of: 0.517015468878227
WordScorePoS
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Label: 3, with a score of: 0.338757428926662
WordScorePoS
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vaccinations improvements in food safety and vector control and introduction of more effective sewerage system Berg

Label: 2, with a score of: 0.752619982095333
WordScorePoS
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Label: 12, with a score of: 0.382293438229077
WordScorePoS
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Many of the newly adopted health protection policies were APPROACHES TO ENVIRONMENTAL HEALTH BOX

Label: 3, with a score of: 0.617617056311128
WordScorePoS
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Label: 10, with a score of: 0.422366581563323
WordScorePoS
newly0RB
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Label: 5, with a score of: 0.341994849225792
WordScorePoS
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Label: 12, with a score of: 0.335685214816094
WordScorePoS
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Label: 1, with a score of: 0.324580452043996
WordScorePoS
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Combating Disease through Improved Milk In the early th century one avenue of attack on preventable deaths of children was through improvements in milk

Label: 3, with a score of: 0.783997776142991
WordScorePoS
combate0NN
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Label: 13, with a score of: 0.329271782187229
WordScorePoS
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Label: 6, with a score of: 0.374579052207131
WordScorePoS
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In New York cross sectoral collaboration between different government and nongovernmental agencies began as they worked together to combat disease

Label: 3, with a score of: 0.763191298474024
WordScorePoS
government0NN
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Label: 16, with a score of: 0.354715840124594
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Label: 15, with a score of: 0.341440595632494
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Label: 6, with a score of: 0.333518999707
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Nurses visited mothers of newborn babies and promoted hygiene and breastfeeding of babies Moser Jones

Label: 3, with a score of: 0.826356927364624
WordScorePoS
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Label: 6, with a score of: 0.532508326807792
WordScorePoS
mother0NN
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Organized milk stations were set up to provide clean and preheated milk to inner city inhabitants

Label: 11, with a score of: 0.940638850306739
WordScorePoS
organize0VB
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Label: 7, with a score of: 0.185308557453518
WordScorePoS
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Inspectors began to scrutinize milk production facilities farms and associated workers to ensure hygienic conditions for milk Moser Jones

Label: 2, with a score of: 0.695354121546642
WordScorePoS
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Label: 8, with a score of: 0.563086397684181
WordScorePoS
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Label: 12, with a score of: 0.320998572751004
WordScorePoS
production0.118934074671047NN
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Railway companies were advised to have their milk cars properly refrigerated

Label: 12, with a score of: 1
WordScorePoS
company0.108503934593034NN
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The city authority began to supervise the distribution and sale of milk

Label: 11, with a score of: 0.997380969185671
WordScorePoS
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The New York City Health Department took the lead in coordinating the efforts of its mandate to secure safe and hygienic food chain from farm to child

Label: 2, with a score of: 0.63278583802136
WordScorePoS
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Label: 11, with a score of: 0.608442555420029
WordScorePoS
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Label: 3, with a score of: 0.275068687332194
WordScorePoS
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Label: 12, with a score of: 0.251895863733447
WordScorePoS
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In many cases it worked closely with the courts to enforce regulations

Label: 16, with a score of: 0.717029526501845
WordScorePoS
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Label: 10, with a score of: 0.651980604596393
WordScorePoS
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Today different mandates in the legal framework perform the same task in the different stages of the production process Rosen

Label: 9, with a score of: 0.520648842739933
WordScorePoS
mandate0NN
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Label: 12, with a score of: 0.503700808329464
WordScorePoS
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Label: 2, with a score of: 0.385630334023345
WordScorePoS
mandate0.0583416713841148NN
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Label: 8, with a score of: 0.317718360400227
WordScorePoS
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based on field evidence and the result of multisectoral collaboration

Label: 10, with a score of: 0.72883789149671
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Label: 6, with a score of: 0.38489142828494
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After local health protection activities had proved successful and enough local level experience had been accumulated the state played key role in scaling up the interventions Rosen

Label: 3, with a score of: 0.572434025019952
WordScorePoS
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Third Generation Hands on Scaling Up In the beginning of the th century much of environmental health work focused on providing rural sanitation Berg

Label: 6, with a score of: 0.493573396616805
WordScorePoS
generation0NN
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Label: 13, with a score of: 0.364688518160658
WordScorePoS
generation0NN
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Label: 3, with a score of: 0.333802495951034
WordScorePoS
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Label: 2, with a score of: 0.30410616824641
WordScorePoS
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Label: 9, with a score of: 0.441696285862364
WordScorePoS
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This period was characterized by community based approach in which public health nurses made visits to homes and then informed sanitarians who would address issues related to food safety garbage collection sanitation vector control and access to drinking water Berg

Label: 6, with a score of: 0.789970301854989
WordScorePoS
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Label: 12, with a score of: 0.38141318583499
WordScorePoS
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Label: 2, with a score of: 0.244288878838364
WordScorePoS
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Label: 3, with a score of: 0.234084612454087
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In the United States the result was the most rapid reduction in morbidity and mortality especially among children in history Berg Cutler and Miller

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WordScorePoS
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Label: 13, with a score of: 0.32310588403781
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With time scientific knowledge evolved containment measures became more sophisticated and some infectious disease outbreaks were gradually brought under control with improved sanitation and the discovery of new vaccines WHO

Label: 6, with a score of: 0.650980008868635
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Label: 3, with a score of: 0.581475502777946
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Fourth Generation The Invisible Regulator By the middle of the th century the institutional framework that regulates environmental health issues had become well established in the developed world Berg

Label: 13, with a score of: 0.626480544211696
WordScorePoS
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Label: 3, with a score of: 0.387826228323808
WordScorePoS
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Label: 9, with a score of: 0.363208687148628
WordScorePoS
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Label: 12, with a score of: 0.355914211147369
WordScorePoS
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Mandates and responsibilities for the different agencies involved in environmental health had been established

Label: 3, with a score of: 0.506647153986304
WordScorePoS
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Label: 12, with a score of: 0.608911791519497
WordScorePoS
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Label: 5, with a score of: 0.392523680470248
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With dramatic improvements in ENVIRONMENTAL HEALTH AND CHILD SURVIVAL environmental health conditions after World War II the work of sanitarians evolved from more visible hands on type of work to less visible regulation based functions as health inspectors Berg

Label: 3, with a score of: 0.714246458221733
WordScorePoS
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Agenda Falling through the Cracks The middle of the th century saw rise in ecological awareness in the developed world heralded by the publication and widespread reading of Rachel Carson Silent Spring and the subsequent occurrence of numerous industrially related public health outbreaks

Label: 13, with a score of: 0.622244746027715
WordScorePoS
agenda0NN
fall0NN
middle0JJ
century0.219293228426234NN
rise0.120914181920259NN
awareness0.0414107553022249NN
develop0VB
world0.00351929966767313NN
related0.0168470026160727JJ
public0NN
health0NN

Label: 3, with a score of: 0.541081906624532
WordScorePoS
agenda0NN
fall0.123094312756122NN
middle0JJ
century0NN
rise0NN
awareness0NN
develop0VB
world0.00087176582269799NN
related0.0125195145191824JJ
public0.021678073222951NN
health0.191387734041787NN

Growing concern about environmental exposures to industrial emissions led to the passage of numerous environmental laws and the creation of the independent environmental agencies

Label: 9, with a score of: 0.532988266496876
WordScorePoS
grow0.0188543197850406VB
environmental0.0221298700466866JJ
exposure0NN
industrial0.318320101004075JJ
emission0NN
lead0.0188543197850406NN
law0NN
creation0NN
agency0NN

Label: 8, with a score of: 0.37866075621623
WordScorePoS
grow0VB
environmental0.0295821503613099JJ
exposure0NN
industrial0JJ
emission0NN
lead0.0504071033101074NN
law0NN
creation0.160952962344818NN
agency0NN

Label: 13, with a score of: 0.321201939906071
WordScorePoS
grow0.0171695137813101VB
environmental0JJ
exposure0NN
industrial0.0414107553022249JJ
emission0.19598742448524NN
lead0NN
law0NN
creation0NN
agency0NN

Label: 16, with a score of: 0.207793739700004
WordScorePoS
grow0VB
environmental0JJ
exposure0NN
industrial0JJ
emission0NN
lead0NN
law0.164686343640793NN
creation0NN
agency0NN

Label: 12, with a score of: 0.429145012197974
WordScorePoS
grow0.0339811641917276VB
environmental0.0598270388037045JJ
exposure0NN
industrial0JJ
emission0.0554128417527413NN
lead0.0169905820958638NN
law0NN
creation0NN
agency0.0542519672965169NN

Label: 1, with a score of: 0.319086860090938
WordScorePoS
grow0VB
environmental0.0442083771593746JJ
exposure0.120266261535276NN
industrial0JJ
emission0NN
lead0NN
law0NN
creation0NN
agency0NN

Increased emphasis on environmental laws and compliance ensued and environmental health staff members were moved into these new environmental agencies

Label: 3, with a score of: 0.382018689561194
WordScorePoS
increase0.0143984997539974NN
environmental0JJ
law0NN
health0.191387734041787NN
move0NN
agency0NN

Label: 16, with a score of: 0.305721427647649
WordScorePoS
increase0NN
environmental0JJ
law0.164686343640793NN
health0NN
move0NN
agency0NN

Label: 12, with a score of: 0.590850953706376
WordScorePoS
increase0.00958677785775002NN
environmental0.0598270388037045JJ
law0NN
health0.0339811641917276NN
move0.0409791940864438NN
agency0.0542519672965169NN

Over time these staff members identified more with environmentalists often forgetting their public health roots as they morphed into their new roles relating to environmental regulation Kotchian

Label: 3, with a score of: 0.518475789953074
WordScorePoS
time0.0127591822694525NN
identify0VB
public0.021678073222951NN
health0.191387734041787NN
environmental0JJ
regulation0NN

Label: 10, with a score of: 0.551122911754518
WordScorePoS
time0.0607862199751165NN
identify0VB
public0.0172128079963482NN
health0.0405241466500776NN
environmental0.0237821918091848JJ
regulation0.0977392570420122NN

Their counterparts in state level health agencies epidemiologists and other health personnel also began to lose their public health roles as budgets and agendas began to emphasize treatment over prevention

Label: 3, with a score of: 0.831060987090073
WordScorePoS
level0NN
health0.191387734041787NN
agency0NN
lose0VB
public0.021678073222951NN
agenda0NN
treatment0.0624189222007589NN
prevention0.0923207345670913NN

With growing attention to health care delivery and hospital regulation public health programs lost visibility and influence in the agenda of state health agencies Kotchian

Label: 3, with a score of: 0.729101009309881
WordScorePoS
grow0VB
attention0NN
health0.191387734041787NN
care0.104031537001265NN
regulation0NN
public0.021678073222951NN
lose0VB
influence0NN
agenda0NN
agency0NN

Label: 5, with a score of: 0.351290296736912
WordScorePoS
grow0VB
attention0NN
health0.0571058915334038NN
care0.0931221694711702NN
regulation0NN
public0.0727679293221751NN
lose0VB
influence0NN
agenda0NN
agency0NN

Label: 10, with a score of: 0.32988362658684
WordScorePoS
grow0.0405241466500776VB
attention0.0396106020715138NN
health0.0405241466500776NN
care0NN
regulation0.0977392570420122NN
public0.0172128079963482NN
lose0VB
influence0NN
agenda0NN
agency0NN

Decades later the same pattern has been followed in developing countries

Label: 13, with a score of: 0.858740364330126
WordScorePoS
decade0.124232265906675NN
pattern0.0414107553022249NN
develop0VB
country0NN

Label: 12, with a score of: 0.424895510875371
WordScorePoS
decade0NN
pattern0.0819583881728876NN
develop0VB
country0NN

At one end is growing environmental movement with the creation of ministries of environment and accompanying policies and regulations while at the other end are health ministries and state health departments engaged in strengthening health systems and scaling up health sector programs that focus mainly on patient care

Label: 3, with a score of: 0.65005521024486
WordScorePoS
grow0VB
environmental0JJ
creation0NN
environment0NN
policy0NN
regulation0NN
health0.191387734041787NN
engage0VB
strengthen0.0150256708965218VB
system0NN
scale0NN
sector0NN
focus0NN
care0.104031537001265NN

Label: 8, with a score of: 0.272712557922206
WordScorePoS
grow0VB
environmental0.0295821503613099JJ
creation0.160952962344818NN
environment0.0591643007226199NN
policy0.0452169560888236NN
regulation0NN
health0NN
engage0VB
strengthen0.00989353561471291VB
system0NN
scale0NN
sector0.0252035516550537NN
focus0.0410992516792148NN
care0NN

Label: 12, with a score of: 0.324886386838231
WordScorePoS
grow0.0339811641917276VB
environmental0.0598270388037045JJ
creation0NN
environment0.079769385071606NN
policy0.0203215381458133NN
regulation0NN
health0.0339811641917276NN
engage0.0819583881728876VB
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system0NN
scale0NN
sector0.0169905820958638NN
focus0NN
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Label: 9, with a score of: 0.312760669648452
WordScorePoS
grow0.0188543197850406VB
environmental0.0221298700466866JJ
creation0NN
environment0.0221298700466866NN
policy0.011275328195446NN
regulation0NN
health0.0377086395700813NN
engage0.0454743001434393VB
strengthen0VB
system0NN
scale0.0368585655748969NN
sector0.0565629593551219NN
focus0.030745604615229NN
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Label: 5, with a score of: 0.311584644795252
WordScorePoS
grow0VB
environmental0JJ
creation0NN
environment0NN
policy0.0341506708422088NN
regulation0NN
health0.0571058915334038NN
engage0VB
strengthen0.0112083245137075VB
system0NN
scale0NN
sector0.0571058915334038NN
focus0NN
care0.0931221694711702NN

Label: 10, with a score of: 0.306371411234584
WordScorePoS
grow0.0405241466500776VB
environmental0.0237821918091848JJ
creation0NN
environment0NN
policy0.0848203862485078NN
regulation0.0977392570420122NN
health0.0405241466500776NN
engage0VB
strengthen0.00795378154685591VB
system0NN
scale0NN
sector0NN
focus0NN
care0NN

Environmental and infrastructure investments are not usually considered to be key determinants of human health by governments and health ministries the latter tend to think of health investments in terms of number of hospital beds and doctors per person Lvovsky

Label: 3, with a score of: 0.571930505329299
WordScorePoS
environmental0JJ
infrastructure0NN
investment0NN
key0NN
human0JJ
health0.191387734041787NN
government0NN
term0NN
person0NN

Label: 9, with a score of: 0.412540832210876
WordScorePoS
environmental0.0221298700466866JJ
infrastructure0.192202909044225NN
investment0.0377086395700813NN
key0NN
human0.011275328195446JJ
health0.0377086395700813NN
government0NN
term0NN
person0NN

Label: 17, with a score of: 0.363573789044694
WordScorePoS
environmental0JJ
infrastructure0.0130185595639838NN
investment0.0766240489430275NN
key0NN
human0JJ
health0NN
government0.048933054487825NN
term0.149793392961411NN
person0NN

In the process the environmental health agenda has fallen between the cracks

Label: 3, with a score of: 0.770910681747615
WordScorePoS
process0NN
environmental0JJ
health0.191387734041787NN
agenda0NN
fall0.123094312756122NN

Label: 9, with a score of: 0.327393792818809
WordScorePoS
process0.0737171311497939NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
agenda0NN
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It has become an institutional orphan as it is increasingly neglected in the programs of both the health and environment ministries

Label: 3, with a score of: 0.768877990420186
WordScorePoS
institutional0JJ
neglect0.0407408489778079NN
health0.191387734041787NN
environment0NN

Label: 12, with a score of: 0.376775201869049
WordScorePoS
institutional0JJ
neglect0NN
health0.0339811641917276NN
environment0.079769385071606NN

Numerous other factors compound this relative neglect of the environmental health agenda in developing countries

Label: 3, with a score of: 0.69589195866874
WordScorePoS
relative0JJ
neglect0.0407408489778079NN
environmental0JJ
health0.191387734041787NN
agenda0NN
develop0VB
country0NN

Label: 11, with a score of: 0.449122427932171
WordScorePoS
relative0.0731385760866977JJ
neglect0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
agenda0NN
develop0VB
country0NN

High level political commitment is critical issue that is often lacking or if it exists does not get translated into effective policy discussions and actions

Label: 17, with a score of: 0.551732522051474
WordScorePoS
level0.0138997399903163NN
political0JJ
commitment0.0739231123597559NN
critical0.036961556179878JJ
issue0.0299586785922821NN
lack0NN
exist0.0599173571845643VB
effective0.0219686053934784JJ
policy0.0641521854453136NN
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Label: 5, with a score of: 0.397210418094569
WordScorePoS
level0.0172651853471334NN
political0.111637082206855JJ
commitment0NN
critical0JJ
issue0NN
lack0NN
exist0VB
effective0.02046578088155JJ
policy0.0341506708422088NN
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Label: 10, with a score of: 0.341708344127766
WordScorePoS
level0NN
political0.0792212041430275JJ
commitment0NN
critical0JJ
issue0NN
lack0NN
exist0VB
effective0.0145231653596925JJ
policy0.0848203862485078NN
action0.0145231653596925NN

Label: 13, with a score of: 0.311462982449666
WordScorePoS
level0.0415277415054218NN
political0JJ
commitment0.0414107553022249NN
critical0JJ
issue0.0335649154577099NN
lack0NN
exist0VB
effective0.0123065238088614JJ
policy0.0102677744436108NN
action0.0369195714265843NN

Additionally both donor agencies and government investments work in isolated silos where investments in agriculture nutrition infrastructure education the environment and health are often not well linked

Label: 2, with a score of: 0.515539959117538
WordScorePoS
additionally0RB
agency0NN
government0NN
investment0.0182713919265625NN
agriculture0.148975141598503NN
nutrition0.175025014152344NN
infrastructure0.0155217067874935NN
education0NN
environment0.0214456704626236NN
health0NN

Label: 9, with a score of: 0.45393490558676
WordScorePoS
additionally0RB
agency0NN
government0NN
investment0.0377086395700813NN
agriculture0NN
nutrition0NN
infrastructure0.192202909044225NN
education0.022550656390892NN
environment0.0221298700466866NN
health0.0377086395700813NN

Label: 4, with a score of: 0.35562373630659
WordScorePoS
additionally0RB
agency0NN
government0NN
investment0NN
agriculture0NN
nutrition0NN
infrastructure0NN
education0.244244978014045NN
environment0.0299609328954485NN
health0NN

Label: 3, with a score of: 0.268006793878698
WordScorePoS
additionally0RB
agency0NN
government0NN
investment0NN
agriculture0NN
nutrition0NN
infrastructure0NN
education0.0152605842304358NN
environment0NN
health0.191387734041787NN

Label: 12, with a score of: 0.304435631483939
WordScorePoS
additionally0RB
agency0.0542519672965169NN
government0NN
investment0NN
agriculture0.0277064208763707NN
nutrition0NN
infrastructure0.028867295332595NN
education0.0101607690729067NN
environment0.079769385071606NN
health0.0339811641917276NN

Providing water and sanitation in urban areas for example has never enjoyed APPROACHES TO ENVIRONMENTAL HEALTH high priority for donors Satterthwaite and funding for child health programs often includes only actions that lie within the health systems framework of the country

Label: 6, with a score of: 0.600755777315802
WordScorePoS
provide0VB
water0.556409482163189NN
sanitation0.334686906581616NN
urban0JJ
approach0NN
environmental0JJ
health0NN
priority0NN
child0.0255958462813622NN
include0VB
action0NN
lie0NN
system0NN
framework0NN
country0NN

Label: 3, with a score of: 0.501386019320694
WordScorePoS
provide0.0100171139310145VB
water0.0382775468083574NN
sanitation0.0249430985430622NN
urban0JJ
approach0NN
environmental0JJ
health0.191387734041787NN
priority0NN
child0.10682408961305NN
include0VB
action0NN
lie0NN
system0NN
framework0.0108390366114755NN
country0NN

Label: 11, with a score of: 0.360406110081182
WordScorePoS
provide0.0269743071558856VB
water0.0458109463416786NN
sanitation0NN
urban0.27622591898666JJ
approach0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
priority0NN
child0.0273960270556257NN
include0VB
action0NN
lie0NN
system0.0315914058171786NN
framework0.0194583992186006NN
country0NN

Label: 12, with a score of: 0.330921381412509
WordScorePoS
provide0.0200087191734851VB
water0.186896403054502NN
sanitation0NN
urban0JJ
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
priority0.0409791940864438NN
child0NN
include0VB
action0.0121782716594324NN
lie0NN
system0NN
framework0.028867295332595NN
country0NN

Country financing is usually allocated by sectors or ministries so unless one sector takes the lead no large scale action can follow Shekar and others

Label: 9, with a score of: 0.551758229957486
WordScorePoS
country0NN
financing0NN
sector0.0565629593551219NN
lead0.0188543197850406NN
scale0.0368585655748969NN
action0.0135141354781442NN

Part of the problem stems from the fact that health ministries tend to focus on interventions in the health care system itself rather than on primary prevention of environmental risks through infrastructural and behavioral interventions

Label: 3, with a score of: 0.810242332695118
WordScorePoS
health0.191387734041787NN
focus0NN
intervention0.0407408489778079NN
care0.104031537001265NN
system0NN
primary0.0108390366114755JJ
prevention0.0923207345670913NN
environmental0JJ
risk0.0703902516159815NN

Label: 5, with a score of: 0.33242214580564
WordScorePoS
health0.0571058915334038NN
focus0NN
intervention0NN
care0.0931221694711702NN
system0NN
primary0.0970239057629001JJ
prevention0NN
environmental0JJ
risk0NN

Institutional coordination at both the national and local levels is often weak

Label: 17, with a score of: 0.664946760648607
WordScorePoS
institutional0.036961556179878JJ
coordination0.0978661089756501NN
national0.0134132459226336JJ
local0.0130185595639838JJ
level0.0138997399903163NN

Label: 13, with a score of: 0.570217534972254
WordScorePoS
institutional0.0828215106044499JJ
coordination0NN
national0.0112708859309299JJ
local0.0145856516935579JJ
level0.0415277415054218NN

Label: 16, with a score of: 0.343680037355187
WordScorePoS
institutional0JJ
coordination0NN
national0.0294647633960925JJ
local0JJ
level0.0610668815653026NN

At the national level poor intersectoral coordination across ministries means that environmental health issues which are inherently cross sectoral in nature are not sufficiently addressed and efforts remain ad hoc and often uncoordinated

Label: 1, with a score of: 0.536120374692308
WordScorePoS
national0.0164833460638534JJ
level0.0113874611101829NN
poor0.150659516460257JJ
coordination0NN
means0.120266261535276NNS
environmental0.0442083771593746JJ
health0NN
issue0NN
nature0NN
address0NN
effort0NN
remain0VB

Label: 12, with a score of: 0.473776251950122
WordScorePoS
national0.00743561777158133JJ
level0.00513687014008325NN
poor0.0339811641917276JJ
coordination0NN
means0NNS
environmental0.0598270388037045JJ
health0.0339811641917276NN
issue0NN
nature0.162755901889551NN
address0NN
effort0NN
remain0VB

Label: 3, with a score of: 0.366797684225785
WordScorePoS
national0.00558382296134999JJ
level0NN
poor0JJ
coordination0NN
means0NNS
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
nature0NN
address0NN
effort0.0127591822694525NN
remain0VB

Many of the environmental health interventions important for child health should be carried out at both the household and the community levels

Label: 3, with a score of: 0.757129057321779
WordScorePoS
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
child0.10682408961305NN
household0NN
community0NN
level0NN

In many developing countries local government authorities who are the best positioned to deliver environmental services and proper hygiene awareness fall short in their efforts because of inadequate funding weak revenue bases and lack of staff members with expertise in environmental health

Label: 3, with a score of: 0.433776340746782
WordScorePoS
develop0VB
country0NN
local0JJ
government0NN
deliver0VB
environmental0JJ
service0.0100171139310145NN
proper0JJ
hygiene0NN
awareness0NN
fall0.123094312756122NN
effort0.0127591822694525NN
inadequate0JJ
revenue0NN
basis0NN
lack0NN
expertise0NN
health0.191387734041787NN

Label: 6, with a score of: 0.345106164709762
WordScorePoS
develop0VB
country0NN
local0.0181797964452808JJ
government0NN
deliver0VB
environmental0JJ
service0.0084006124696649NN
proper0JJ
hygiene0.136665345449673NN
awareness0NN
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effort0NN
inadequate0.0836717266454039JJ
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basis0NN
lack0.0214003646985842NN
expertise0NN
health0NN

Label: 17, with a score of: 0.3699612427079
WordScorePoS
develop0VB
country0NN
local0.0130185595639838JJ
government0.048933054487825NN
deliver0.0299586785922821VB
environmental0JJ
service0NN
proper0JJ
hygiene0NN
awareness0NN
fall0NN
effort0NN
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revenue0.0978661089756501NN
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lack0NN
expertise0.048933054487825NN
health0NN

Local governments are also impoverished powerless and suffering from weak management capacity

Label: 6, with a score of: 0.454407721148164
WordScorePoS
local0.0181797964452808JJ
government0NN
suffer0.041835863322702VB
management0.0428007293971684NN
capacity0.0104991907358033NN

Label: 17, with a score of: 0.429332044069073
WordScorePoS
local0.0130185595639838JJ
government0.048933054487825NN
suffer0VB
management0NN
capacity0.0451108483130998NN

Label: 11, with a score of: 0.398654578611624
WordScorePoS
local0.0194583992186006JJ
government0NN
suffer0VB
management0.0687164195125178NN
capacity0.0112376090361851NN

Label: 15, with a score of: 0.369054925518186
WordScorePoS
local0.0275274877486226JJ
government0NN
suffer0VB
management0.0486060126274891NN
capacity0.0158976666884135NN

In part this state can be explained by the colonial legacy of imported codes and regulations for planning land use management and buildings that were applied only to areas of the colonial city inhabited by nonnatives

Label: 11, with a score of: 0.892805177746633
WordScorePoS
import0NN
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plan0.0583751976558017NN
land0.0389167984372011NN
management0.0687164195125178NN
building0.0747035830159326NN
city0.607697021770652NN

Label: 17, with a score of: 0.313369361842105
WordScorePoS
import0.0978661089756501NN
regulation0.036961556179878NN
plan0.0130185595639838NN
land0NN
management0NN
building0.149940347231585NN
city0NN

Also however the inadequacies of service provision can be attributed to very rapid growth experienced around the time of independence Satterthwaite

Label: 8, with a score of: 0.625587104282574
WordScorePoS
service0.0197870712294258NN
provision0NN
rapid0JJ
growth0.208565600657229NN
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time0NN

Label: 10, with a score of: 0.494553036131689
WordScorePoS
service0.00795378154685591NN
provision0NN
rapid0JJ
growth0.11178243319132NN
experienced0JJ
time0.0607862199751165NN

Finally in many developing countries the crumbling or inadequate infrastructure underfinancing and lack of personnel have eroded health systems even as the burden of disease has increased

Label: 3, with a score of: 0.62128560339936
WordScorePoS
develop0VB
country0NN
inadequate0JJ
infrastructure0NN
lack0NN
health0.191387734041787NN
system0NN
burden0NN
disease0.215415047323213NN
increase0.0143984997539974NN

Label: 9, with a score of: 0.500464733924038
WordScorePoS
develop0VB
country0NN
inadequate0.0368585655748969JJ
infrastructure0.192202909044225NN
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burden0NN
disease0NN
increase0.0159575617614215NN

Label: 6, with a score of: 0.34742651363253
WordScorePoS
develop0VB
country0NN
inadequate0.0836717266454039JJ
infrastructure0.0181797964452808NN
lack0.0214003646985842NN
health0NN
system0NN
burden0NN
disease0.103230094596636NN
increase0.00905621749519576NN

Governments in developing countries find implementing and rehabilitating water infrastructure without donor support difficult

Label: 6, with a score of: 0.817021785649334
WordScorePoS
government0NN
develop0VB
country0NN
implement0.0127979231406811VB
water0.556409482163189NN
infrastructure0.0181797964452808NN
support0.0209983814716066NN

Label: 9, with a score of: 0.346022821794524
WordScorePoS
government0NN
develop0VB
country0NN
implement0VB
water0.0377086395700813NN
infrastructure0.192202909044225NN
support0.0277502419802315NN

Label: 12, with a score of: 0.328241247960554
WordScorePoS
government0NN
develop0VB
country0NN
implement0.0203215381458133VB
water0.186896403054502NN
infrastructure0.028867295332595NN
support0.00833571598658786NN

For example in Central Asia government budgets for operation and maintenance dropped from US per hectare to less than US per hectare

Label: 15, with a score of: 0.964382536727936
WordScorePoS
central0JJ
asia0IN
government0NN
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The result is that infrastructure is rapidly deteriorating World Water Forum

Label: 6, with a score of: 0.880856311670044
WordScorePoS
result0.0683326727248364NN
infrastructure0.0181797964452808NN
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world0.00438651305628668NN
water0.556409482163189NN
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Label: 9, with a score of: 0.316369261452452
WordScorePoS
result0NN
infrastructure0.192202909044225NN
rapidly0RB
world0.00257642711761688NN
water0.0377086395700813NN
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Label: 12, with a score of: 0.29992975621586
WordScorePoS
result0NN
infrastructure0.028867295332595NN
rapidly0RB
world0.00464349782489754NN
water0.186896403054502NN
forum0NN

In the case of sanitation more work needs to be done because

Label: 6, with a score of: 0.974015383506891
WordScorePoS
sanitation0.334686906581616NN

billion people lack adequate sanitation

Label: 6, with a score of: 0.841854769265707
WordScorePoS
people0.024149913320522NNS
lack0.0214003646985842NN
adequate0.0295155485671997JJ
sanitation0.334686906581616NN

Label: 1, with a score of: 0.337907775666377
WordScorePoS
people0.0371911007748996NNS
lack0.0753297582301286NN
adequate0.0519476926891779JJ
sanitation0NN

Label: 9, with a score of: 0.305915852266893
WordScorePoS
people0.0186171553883251NNS
lack0.0565629593551219NN
adequate0JJ
sanitation0.0737171311497939NN

Rapid urbanization and uncontrolled growth of urban slums are now creating double environmental health burden for the urban poor

Label: 11, with a score of: 0.853497501161437
WordScorePoS
rapid0.0373517915079663JJ
urbanization0.146277152173395NN
growth0NN
urban0.27622591898666JJ
slum0.146277152173395NN
create0.0315914058171786VB
double0RB
environmental0.0537696560159885JJ
health0.0229054731708393NN
burden0NN
poor0.0229054731708393JJ

Label: 8, with a score of: 0.259089780362741
WordScorePoS
rapid0JJ
urbanization0NN
growth0.208565600657229NN
urban0JJ
slum0NN
create0.0695218668857431VB
double0RB
environmental0.0295821503613099JJ
health0NN
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Label: 1, with a score of: 0.251589717773572
WordScorePoS
rapid0JJ
urbanization0NN
growth0.0519476926891779NN
urban0JJ
slum0NN
create0.0519476926891779VB
double0RB
environmental0.0442083771593746JJ
health0NN
burden0NN
poor0.150659516460257JJ

Label: 3, with a score of: 0.178689426554312
WordScorePoS
rapid0.020806307400253JJ
urbanization0NN
growth0NN
urban0JJ
slum0NN
create0VB
double0RB
environmental0JJ
health0.191387734041787NN
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Poor urban people are exposed to health risks associated with dirty cooking fuels traditional stoves crowding and poor access to water and sanitation Satterthwaite

Label: 6, with a score of: 0.764956806752073
WordScorePoS
poor0.0642010940957526JJ
urban0JJ
people0.024149913320522NNS
health0NN
risk0NN
cooking0NN
fuel0NN
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access0.00731085509381114NN
water0.556409482163189NN
sanitation0.334686906581616NN

Label: 11, with a score of: 0.346719621279833
WordScorePoS
poor0.0229054731708393JJ
urban0.27622591898666JJ
people0.0161552501392041NNS
health0.0229054731708393NN
risk0.0631828116343571NN
cooking0NN
fuel0NN
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access0.00626002771693937NN
water0.0458109463416786NN
sanitation0NN

Label: 1, with a score of: 0.287946922011045
WordScorePoS
poor0.150659516460257JJ
urban0JJ
people0.0371911007748996NNS
health0NN
risk0.0519476926891779NN
cooking0NN
fuel0NN
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access0.00514687440545096NN
water0NN
sanitation0NN

Label: 3, with a score of: 0.244926975445618
WordScorePoS
poor0JJ
urban0JJ
people0.00539943740774902NNS
health0.191387734041787NN
risk0.0703902516159815NN
cooking0NN
fuel0NN
traditional0JJ
access0.00610236075888593NN
water0.0382775468083574NN
sanitation0.0249430985430622NN

Label: 12, with a score of: 0.244824933951112
WordScorePoS
poor0.0339811641917276JJ
urban0JJ
people0.0119834723221875NNS
health0.0339811641917276NN
risk0NN
cooking0NN
fuel0.0332151194779746NN
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access0.00232174891244877NN
water0.186896403054502NN
sanitation0NN

This neglect of environmental health within the national and local agendas of developing countries is critical especially because the major environmental health concerns poor water and sanitation access inappropriate hygienic practices lack of vector control and continued indoor air pollution are the same ones that developed countries faced about century ago Rosen

Label: 6, with a score of: 0.645000835874641
WordScorePoS
neglect0NN
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national0JJ
local0.0181797964452808JJ
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water0.556409482163189NN
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Label: 12, with a score of: 0.365753663756726
WordScorePoS
neglect0NN
environmental0.0598270388037045JJ
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national0.00743561777158133JJ
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Label: 3, with a score of: 0.345512982392927
WordScorePoS
neglect0.0407408489778079NN
environmental0JJ
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national0.00558382296134999JJ
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air0.020806307400253NN
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century0NN

Label: 1, with a score of: 0.241570657849694
WordScorePoS
neglect0NN
environmental0.0442083771593746JJ
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national0.0164833460638534JJ
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poor0.150659516460257JJ
water0NN
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Label: 13, with a score of: 0.191227058576974
WordScorePoS
neglect0NN
environmental0JJ
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national0.0112708859309299JJ
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Whatever the root causes for the poor environmental conditions and neglect of the environmental health ENVIRONMENTAL HEALTH AND CHILD SURVIVAL arm of the primary prevention agenda by the health sector the current reality in developing countries demands revitalized approach to implementing environmental health interventions given its importance for child survival

Label: 3, with a score of: 0.678897962373167
WordScorePoS
poor0JJ
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Label: 1, with a score of: 0.265129903207916
WordScorePoS
poor0.150659516460257JJ
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Label: 12, with a score of: 0.352989797692464
WordScorePoS
poor0.0339811641917276JJ
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Many governments in developing countries have increasingly begun to recognize the importance of environmental health in child survival poverty reduction and economic growth and they are beginning to incorporate environmental health activities into existing integrated child development and nutrition programs

Label: 3, with a score of: 0.432627512731341
WordScorePoS
government0NN
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Label: 8, with a score of: 0.428944906949396
WordScorePoS
government0NN
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Label: 1, with a score of: 0.421610393948088
WordScorePoS
government0NN
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Label: 2, with a score of: 0.241914867108151
WordScorePoS
government0NN
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nutrition0.175025014152344NN

Label: 10, with a score of: 0.354629082815592
WordScorePoS
government0NN
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environmental0.0237821918091848JJ
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Additionally successful community level initiatives such as the Total Sanitation Campaign in Bangladesh are beginning to take root and to spread to other countries and regions WSP

Label: 6, with a score of: 0.716341960573743
WordScorePoS
additionally0RB
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Label: 1, with a score of: 0.357459422343216
WordScorePoS
additionally0RB
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Label: 3, with a score of: 0.348095327175537
WordScorePoS
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In the following section this chapter provides an illustrative list of different projects that have either recognized the need or incorporated environmental health into current policies programs and projects such as child survival nutrition and water and sanitation

Label: 6, with a score of: 0.788672054562024
WordScorePoS
project0.041835863322702NN
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Label: 12, with a score of: 0.368256059134982
WordScorePoS
project0.0664302389559493NN
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Label: 3, with a score of: 0.284947977774288
WordScorePoS
project0NN
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Label: 2, with a score of: 0.181059446485553
WordScorePoS
project0NN
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Environmental Health Experiences in Developing Countries Developing countries themselves vary considerably in terms of institutional capacity political will and socioeconomic development

Label: 17, with a score of: 0.562046670170455
WordScorePoS
environmental0JJ
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Label: 3, with a score of: 0.420421354692052
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.365642972691966
WordScorePoS
environmental0.0237821918091848JJ
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Label: 5, with a score of: 0.329903497566832
WordScorePoS
environmental0JJ
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Environmental health interventions therefore need to be customized to the specific enabling environment in developing country

Label: 3, with a score of: 0.576737992983953
WordScorePoS
environmental0JJ
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Label: 12, with a score of: 0.566056789704831
WordScorePoS
environmental0.0598270388037045JJ
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Label: 11, with a score of: 0.350104059041471
WordScorePoS
environmental0.0537696560159885JJ
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Recognizing these differences rather than providing specific recommendations this section presents examples of how some developing countries are beginning to mainstream environmental health components and objectives within existing child survival programs nutrition initiatives and infrastructure projects water and sanitation rural energy

Label: 6, with a score of: 0.604732572855412
WordScorePoS
recognize0VB
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Label: 7, with a score of: 0.443264251291412
WordScorePoS
recognize0VB
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Label: 12, with a score of: 0.376378795327539
WordScorePoS
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energy0.133960988253756NN

Label: 9, with a score of: 0.30396251138759
WordScorePoS
recognize0.0368585655748969VB
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Label: 2, with a score of: 0.26136916605246
WordScorePoS
recognize0VB
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Label: 3, with a score of: 0.226428459123583
WordScorePoS
recognize0VB
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As countries develop and their institutional capacity strengthens they move toward more truly multisectoral programs that seek to address environmental health

Label: 3, with a score of: 0.527126385656822
WordScorePoS
country0NN
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Label: 1, with a score of: 0.407662729661424
WordScorePoS
country0NN
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Label: 12, with a score of: 0.387803446015816
WordScorePoS
country0NN
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Label: 13, with a score of: 0.387258958842862
WordScorePoS
country0NN
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Integrated Child Survival Programs In developing countries several child survival strategies such as immunization campaigns and improved case management of specific diseases have proven to be effective

Label: 3, with a score of: 0.644508396060107
WordScorePoS
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Label: 6, with a score of: 0.378359021332749
WordScorePoS
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Nevertheless accumulating evidence has suggested that child health programs need to move beyond addressing single diseases to addressing the overall health and well being of the child

Label: 3, with a score of: 0.819573893698692
WordScorePoS
evidence0NN
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child0.10682408961305NN
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move0NN
address0NN
single0JJ
disease0.215415047323213NN

Label: 10, with a score of: 0.392009051011735
WordScorePoS
evidence0.12939607756667NN
suggest0VB
child0.0242343960710022NN
health0.0405241466500776NN
move0NN
address0.064698038783335NN
single0JJ
disease0NN

In response during the mid the World Health Organization WHO in collaboration with the United Nations Children Fund UNICEF and many other agencies institutions and individuals developed strategy known as Integrated Management of Childhood Illness IMCI

Label: 3, with a score of: 0.477441569989267
WordScorePoS
response0NN
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
unite0VB
nation0NN
child0.10682408961305NN
fund0NN
agency0NN
institution0NN
individual0JJ
develop0VB
strategy0.0149758277542848NN
integrate0VB
management0.0127591822694525NN
childhood0NN
illness0.0407408489778079NN

Label: 16, with a score of: 0.415108919162334
WordScorePoS
response0NN
world0NN
health0NN
organization0NN
unite0VB
nation0NN
child0.0603953832457135NN
fund0NN
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individual0JJ
develop0VB
strategy0NN
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childhood0NN
illness0NN

Label: 13, with a score of: 0.380779768466666
WordScorePoS
response0.0548233071065585NN
world0.00351929966767313NN
health0NN
organization0NN
unite0.0828215106044499VB
nation0.0671298309154199NN
child0NN
fund0.0414107553022249NN
agency0NN
institution0NN
individual0JJ
develop0VB
strategy0.0201523636533764NN
integrate0.0201523636533764VB
management0.0171695137813101NN
childhood0NN
illness0NN

Label: 10, with a score of: 0.370523666601046
WordScorePoS
response0NN
world0.00276879546803864NN
health0.0405241466500776NN
organization0.02794560829783NN
unite0VB
nation0.0396106020715138NN
child0.0242343960710022NN
fund0NN
agency0NN
institution0.0991236547760315NN
individual0.064698038783335JJ
develop0VB
strategy0NN
integrate0VB
management0NN
childhood0NN
illness0NN

Although the IMCI strategy mostly focuses on better treatment practices in terms of diagnosis medicine administration and the like elements of hygiene are already found within its key practices

Label: 6, with a score of: 0.367807642091133
WordScorePoS
strategy0NN
focus0NN
treatment0.0348974218717993NN
practice0NN
term0NN
diagnosis0NN
medicine0NN
hygiene0.136665345449673NN
key0NN

Label: 17, with a score of: 0.359699123520101
WordScorePoS
strategy0.017987180284335NN
focus0NN
treatment0NN
practice0NN
term0.149793392961411NN
diagnosis0NN
medicine0NN
hygiene0NN
key0NN

Label: 3, with a score of: 0.517164687918094
WordScorePoS
strategy0.0149758277542848NN
focus0NN
treatment0.0624189222007589NN
practice0NN
term0NN
diagnosis0.0407408489778079NN
medicine0.123094312756122NN
hygiene0NN
key0NN

Innovative projects in Cuzco Peru and Chinandega Nicaragua that have promoted key hygiene behaviors within the APPROACHES TO ENVIRONMENTAL HEALTH programmatic framework of their community level IMCI strategies have resulted in significant improvements in health outcomes Favin

Label: 3, with a score of: 0.527748449690909
WordScorePoS
project0NN
promote0.00837573444202498VB
key0NN
hygiene0NN
approach0NN
environmental0JJ
health0.191387734041787NN
framework0.0108390366114755NN
community0NN
level0NN
strategy0.0149758277542848NN
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significant0.0127591822694525JJ
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Label: 6, with a score of: 0.337366252329964
WordScorePoS
project0.041835863322702NN
promote0VB
key0NN
hygiene0.136665345449673NN
approach0NN
environmental0JJ
health0NN
framework0NN
community0.0214003646985842NN
level0.00647010760354177NN
strategy0NN
result0.0683326727248364NN
significant0JJ
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Label: 12, with a score of: 0.386040053437757
WordScorePoS
project0.0664302389559493NN
promote0.0148712355431627VB
key0NN
hygiene0NN
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
framework0.028867295332595NN
community0.0169905820958638NN
level0.00513687014008325NN
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significant0JJ
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In another example the Honduras Integrated Community Based Child Care Program included specific component on hygiene education in addition to advice for improving home care feeding practices and related health behaviors Griffiths and McGuire

Label: 3, with a score of: 0.566825955167797
WordScorePoS
integrate0VB
community0NN
base0.0149758277542848NN
child0.10682408961305NN
care0.104031537001265NN
include0VB
specific0JJ
hygiene0NN
education0.0152605842304358NN
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related0.0125195145191824JJ
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Label: 4, with a score of: 0.44843137452665
WordScorePoS
integrate0VB
community0NN
base0NN
child0.076326555629389NN
care0.0416255041156371NN
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education0.244244978014045NN
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Label: 6, with a score of: 0.322595103342522
WordScorePoS
integrate0.0251182378961834VB
community0.0214003646985842NN
base0NN
child0.0255958462813622NN
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include0VB
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hygiene0.136665345449673NN
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Label: 5, with a score of: 0.362409629727851
WordScorePoS
integrate0VB
community0NN
base0NN
child0.0170753354211044NN
care0.0931221694711702NN
include0VB
specific0JJ
hygiene0NN
education0.0512260062633133NN
addition0NN
improve0VB
practice0.0393804437159645NN
related0JJ
health0.0571058915334038NN

Similarly the Integrated Child Development Services in India has included hygiene awareness such as hand washing practices for children within multisectoral approach that incorporates health education and nutrition interventions Gragnolati and others

Label: 3, with a score of: 0.512227468495974
WordScorePoS
integrate0VB
child0.10682408961305NN
development0.00837573444202498NN
service0.0100171139310145NN
include0VB
hygiene0NN
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health0.191387734041787NN
education0.0152605842304358NN
nutrition0NN
intervention0.0407408489778079NN

Label: 4, with a score of: 0.453887704626069
WordScorePoS
integrate0VB
child0.076326555629389NN
development0.0279277626235394NN
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hygiene0NN
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education0.244244978014045NN
nutrition0NN
intervention0NN

Label: 2, with a score of: 0.363076608155743
WordScorePoS
integrate0VB
child0.0546336178945768NN
development0.0159922815774215NN
service0.0143446978608332NN
include0VB
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nutrition0.175025014152344NN
intervention0NN

Label: 6, with a score of: 0.236519960795773
WordScorePoS
integrate0.0251182378961834VB
child0.0255958462813622NN
development0NN
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nutrition0NN
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Label: 12, with a score of: 0.320065046257754
WordScorePoS
integrate0.0199423462679015VB
child0NN
development0.022306853314744NN
service0.00666957305782837NN
include0VB
hygiene0NN
awareness0.0819583881728876NN
practice0.0703006268489394NN
approach0.0542519672965169NN
health0.0339811641917276NN
education0.0101607690729067NN
nutrition0NN
intervention0NN

few integrated child survival programs have been even more comprehensive including components that traditionally lie outside the health sector but that have important health effects

Label: 3, with a score of: 0.778365018161696
WordScorePoS
integrate0VB
child0.10682408961305NN
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For example subcomponent of the Eritrea Integrated Early Childhood Development Project included environmental health interventions to control childhood illnesses through promotion maintenance and use of safe latrines improved food safety and hygiene water source protection and handling prevention of acute respiratory infections through indoor air pollution reduction interventions for example promotion of improved kitchen and household ventilation and improved collaboration in the prevention of malaria and other vectorborne diseases see World Bank

Label: 6, with a score of: 0.570842332690643
WordScorePoS
integrate0.0251182378961834VB
childhood0NN
development0NN
project0.041835863322702NN
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intervention0NN
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promotion0NN
safe0.0428007293971684JJ
latrine0.0683326727248364NN
improve0.0511916925627245VB
food0.0214003646985842NN
safety0NN
hygiene0.136665345449673NN
water0.556409482163189NN
source0.0613562156822703NN
protection0NN
prevention0NN
infection0NN
air0NN
pollution0.0590310971343993NN
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malaria0NN
disease0.103230094596636NN
world0.00438651305628668NN
bank0NN

Label: 3, with a score of: 0.535327002025524
WordScorePoS
integrate0VB
childhood0NN
development0.00837573444202498NN
project0NN
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health0.191387734041787NN
intervention0.0407408489778079NN
control0.020806307400253NN
illness0.0407408489778079NN
promotion0NN
safe0.0127591822694525JJ
latrine0NN
improve0VB
food0NN
safety0NN
hygiene0NN
water0.0382775468083574NN
source0NN
protection0.020806307400253NN
prevention0.0923207345670913NN
infection0.122222546933424NN
air0.020806307400253NN
pollution0.0175975629039954NN
reduction0.0149758277542848NN
household0NN
malaria0.20370424488904NN
disease0.215415047323213NN
world0.00087176582269799NN
bank0NN

Label: 12, with a score of: 0.366070810646964
WordScorePoS
integrate0.0199423462679015VB
childhood0NN
development0.022306853314744NN
project0.0664302389559493NN
include0VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
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illness0NN
promotion0NN
safe0JJ
latrine0NN
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food0.186896403054502NN
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hygiene0NN
water0.186896403054502NN
source0NN
protection0NN
prevention0.0409791940864438NN
infection0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
reduction0.0199423462679015NN
household0.0554128417527413NN
malaria0NN
disease0NN
world0.00464349782489754NN
bank0NN

Label: 2, with a score of: 0.239995114160754
WordScorePoS
integrate0VB
childhood0NN
development0.0159922815774215NN
project0NN
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health0NN
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illness0NN
promotion0NN
safe0.0182713919265625JJ
latrine0NN
improve0.0218534471578307VB
food0.292342270824999NN
safety0NN
hygiene0NN
water0NN
source0.0130963126055467NN
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infection0NN
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household0.0297950283197006NN
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world0.0124838525528648NN
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Other child survival programs in low income countries such as Bangladesh Benin Brazil Cambodia Eritrea Haiti Malawi Nepal and Nicaragua have included vector control measures use of insecticide treated mosquito nets as part of their preventive interventions Victora and others

Label: 10, with a score of: 0.424792411493873
WordScorePoS
child0.0242343960710022NN
income0.166475342664294NN
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Label: 1, with a score of: 0.567042370515475
WordScorePoS
child0.0450489732120807NN
income0.0442083771593746NN
country0NN
include0VB
control0.0614198493690006NN
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Some middle income countries have begun to address child mortality more systematically by moving beyond health system interventions to more integrated multisectoral program with strong political commitment from the government

Label: 3, with a score of: 0.684871019287863
WordScorePoS
middle0JJ
income0NN
country0NN
child0.10682408961305NN
mortality0.276962203701274NN
move0NN
health0.191387734041787NN
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intervention0.0407408489778079NN
integrate0VB
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Label: 10, with a score of: 0.453894667826887
WordScorePoS
middle0JJ
income0.166475342664294NN
country0NN
child0.0242343960710022NN
mortality0.0488696285210061NN
move0NN
health0.0405241466500776NN
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strong0.0488696285210061JJ
political0.0792212041430275JJ
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government0NN

Label: 9, with a score of: 0.323461530199271
WordScorePoS
middle0.0602029956716497JJ
income0.110649350233433NN
country0NN
child0NN
mortality0NN
move0NN
health0.0377086395700813NN
system0NN
intervention0NN
integrate0VB
strong0.0454743001434393JJ
political0.0368585655748969JJ
commitment0NN
government0NN

Costa Rica for example added to years of life expectancy and significantly reduced child mortality in over two decades through number of multisectoral policy actions including targeted program to control infectious diseases through improved sanitation immunization and the extension of primary health care to wider population World Resources Institute and others

Label: 3, with a score of: 0.676404314229754
WordScorePoS
add0VB
life0.0250390290383647NN
expectancy0.0407408489778079NN
significantly0RB
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child0.10682408961305NN
mortality0.276962203701274NN
decade0NN
policy0NN
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control0.020806307400253NN
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sanitation0.0249430985430622NN
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primary0.0108390366114755JJ
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care0.104031537001265NN
population0NN
world0.00087176582269799NN
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Label: 6, with a score of: 0.376127184373853
WordScorePoS
add0VB
life0NN
expectancy0NN
significantly0RB
reduce0.00936547854413134VB
child0.0255958462813622NN
mortality0NN
decade0NN
policy0NN
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disease0.103230094596636NN
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population0.0363595928905615NN
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In Mexico the government brought about significant improvements in under five mortality by systematically rolling out programs on vaccinations clean water and health reform see box

Label: 6, with a score of: 0.648086029603049
WordScorePoS
government0NN
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clean0.0348974218717993JJ
water0.556409482163189NN
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Label: 3, with a score of: 0.592063981484842
WordScorePoS
government0NN
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significant0.0127591822694525JJ
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mortality0.276962203701274NN
clean0.020806307400253JJ
water0.0382775468083574NN
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Label: 12, with a score of: 0.242086917315139
WordScorePoS
government0NN
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water0.186896403054502NN
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Label: 7, with a score of: 0.238381134802472
WordScorePoS
government0NN
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clean0.125032076213024JJ
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Nutrition Programs Improving the nutritional status of young children requires not only health sector interventions but also appropriate actions in agriculture rural development water supply and sanitation social protection education gender programs and community driven development Shekar and others

Label: 6, with a score of: 0.575896491960073
WordScorePoS
nutrition0NN
improve0.0511916925627245VB
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child0.0255958462813622NN
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sector0.0214003646985842NN
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water0.556409482163189NN
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Label: 2, with a score of: 0.364112492595696
WordScorePoS
nutrition0.175025014152344NN
improve0.0218534471578307VB
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Label: 5, with a score of: 0.305259607092813
WordScorePoS
nutrition0NN
improve0VB
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child0.0170753354211044NN
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health0.0571058915334038NN
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gender0.196902218579822NN
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Label: 4, with a score of: 0.294906016186539
WordScorePoS
nutrition0NN
improve0.0305306222517556VB
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child0.076326555629389NN
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Label: 12, with a score of: 0.260393868023357
WordScorePoS
nutrition0NN
improve0VB
nutritional0JJ
status0NN
child0NN
require0.0468670845659596VB
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education0.0101607690729067NN
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Label: 3, with a score of: 0.254425051901495
WordScorePoS
nutrition0NN
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child0.10682408961305NN
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health0.191387734041787NN
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Reviews of different nutrition programs in Central America Ecuador Thailand Ghana and India ENVIRONMENTAL HEALTH AND CHILD SURVIVAL BOX

Label: 3, with a score of: 0.59731565586379
WordScorePoS
review0NN
nutrition0NN
central0JJ
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child0.10682408961305NN

Label: 2, with a score of: 0.548272733510921
WordScorePoS
review0NN
nutrition0.175025014152344NN
central0.0440683498519077JJ
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Mexico Multisectorality through Diagonal Approach Mexico is one of seven countries on track to achieve the goal of reducing child mortality by Sepúlveda and others

Label: 3, with a score of: 0.847005334073828
WordScorePoS
approach0NN
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Improvement in children health is attributed to two programs that worked together the Clean Water Program and the Universal Vaccination Program

Label: 6, with a score of: 0.73420468407324
WordScorePoS
improvement0NN
child0.0255958462813622NN
health0NN
clean0.0348974218717993JJ
water0.556409482163189NN
universal0.0153390539205676JJ

Label: 3, with a score of: 0.436157927672156
WordScorePoS
improvement0NN
child0.10682408961305NN
health0.191387734041787NN
clean0.020806307400253JJ
water0.0382775468083574NN
universal0.0182906962166331JJ

Label: 7, with a score of: 0.316393091364078
WordScorePoS
improvement0.0924643738905717NN
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universal0.0549574626423028JJ

Label: 12, with a score of: 0.256498927138507
WordScorePoS
improvement0NN
child0NN
health0.0339811641917276NN
clean0JJ
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The Clean Water Program focused on appropriate water chlorination and regulations that for example banned the use of sewage for crop irrigation

Label: 6, with a score of: 0.906827210389133
WordScorePoS
clean0.0348974218717993JJ
water0.556409482163189NN
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irrigation0.0516150472983178NN

Label: 12, with a score of: 0.282628703092642
WordScorePoS
clean0JJ
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irrigation0NN

Label: 7, with a score of: 0.187095625650084
WordScorePoS
clean0.125032076213024JJ
water0NN
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ban0.122412709674631NN
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Important steps in the program were to improve sewage treatment plants to provide adequate disposal of waste and to monitor the maintenance of drainage systems

Label: 2, with a score of: 0.517004904756507
WordScorePoS
improve0.0218534471578307VB
sewage0NN
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plant0.132205049555723NN
provide0.0215170467912497VB
adequate0JJ
waste0.0297950283197006NN
monitor0NN
system0.0756001353333673NN

Label: 12, with a score of: 0.395963054248358
WordScorePoS
improve0VB
sewage0NN
treatment0NN
plant0NN
provide0.0200087191734851VB
adequate0.0234335422829798JJ
waste0.138532104381853NN
monitor0.0332151194779746NN
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Label: 11, with a score of: 0.477745627151352
WordScorePoS
improve0.0273960270556257VB
sewage0.0731385760866977NN
treatment0NN
plant0NN
provide0.0269743071558856VB
adequate0.0631828116343571JJ
waste0.0373517915079663NN
monitor0NN
system0.0315914058171786NN

Label: 15, with a score of: 0.338752266720583
WordScorePoS
improve0VB
sewage0NN
treatment0NN
plant0.117231723668544NN
provide0.0445201436316848VB
adequate0.0223459295604043JJ
waste0NN
monitor0NN
system0NN

The Universal Vaccination Program was created as result of the measles epidemic in and see the accompanying figure

Label: 9, with a score of: 0.578368202021009
WordScorePoS
universal0.0135141354781442JJ
create0.0520080474473126VB
result0NN
measles0NNS
epidemic0JJ
figure0.0602029956716497NN

Label: 3, with a score of: 0.458978709536414
WordScorePoS
universal0.0182906962166331JJ
create0VB
result0NN
measles0.0407408489778079NNS
epidemic0.0407408489778079JJ
figure0NN

The outbreak caused more than cases and deaths in mostly malnourished children under five years of age

Label: 3, with a score of: 0.803032580513967
WordScorePoS
cause0NN
death0.193573191943949NN
child0.10682408961305NN
age0.0893142758861673NN

Label: 1, with a score of: 0.325661802929876
WordScorePoS
cause0NN
death0NN
child0.0450489732120807NN
age0.112994637345193NN

Within three years of the project immunization coverage exceeded percent

Label: 13, with a score of: 0.614338306944808
WordScorePoS
project0.0335649154577099NN
coverage0NN
exceed0.0828215106044499VB

Label: 6, with a score of: 0.493274655437104
WordScorePoS
project0.041835863322702NN
coverage0NN
exceed0.0516150472983178VB

Label: 1, with a score of: 0.479509258703019
WordScorePoS
project0NN
coverage0.0908430554521382NN
exceed0VB

Label: 12, with a score of: 0.350647768051067
WordScorePoS
project0.0664302389559493NN
coverage0NN
exceed0VB

By introducing national health weeks and improving the health monitoring system the authorities focused on immunization vitamin supplementation oral rehydration salts and deworming reaching sustained high population coverage

Label: 3, with a score of: 0.615459362122087
WordScorePoS
introduce0VB
national0.00558382296134999JJ
health0.191387734041787NN
improve0VB
monitor0NN
system0NN
focus0NN
reach0NN
sustained0JJ
population0NN
coverage0.0307735781890304NN

Evidence suggests that high levels of coverage of public health interventions as well as investments in women education social protection water and sanitation all contributed to the success Frenk Sepúlveda and others

Label: 6, with a score of: 0.632845292198725
WordScorePoS
evidence0NN
suggest0VB
level0.00647010760354177NN
coverage0NN
public0NN
health0NN
intervention0NN
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woman0.0127979231406811NN
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social0JJ
protection0NN
water0.556409482163189NN
sanitation0.334686906581616NN
contribute0VB

Label: 5, with a score of: 0.344420883974112
WordScorePoS
evidence0NN
suggest0VB
level0.0172651853471334NN
coverage0NN
public0.0727679293221751NN
health0.0571058915334038NN
intervention0NN
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woman0.221979360474357NN
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social0.0285529457667019JJ
protection0.0465610847355851NN
water0NN
sanitation0NN
contribute0VB

Label: 3, with a score of: 0.293369202996701
WordScorePoS
evidence0NN
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level0NN
coverage0.0307735781890304NN
public0.021678073222951NN
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woman0.0381514605760894NN
education0.0152605842304358NN
social0JJ
protection0.020806307400253NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
contribute0VB

Label: 10, with a score of: 0.28580609391768
WordScorePoS
evidence0.12939607756667NN
suggest0VB
level0NN
coverage0NN
public0.0172128079963482NN
health0.0405241466500776NN
intervention0NN
investment0.0202620733250388NN
woman0.0242343960710022NN
education0.0121171980355011NN
social0.101310366625194JJ
protection0.0660824365173543NN
water0NN
sanitation0NN
contribute0VB

Label: 12, with a score of: 0.234577561294677
WordScorePoS
evidence0NN
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level0.00513687014008325NN
coverage0NN
public0.028867295332595NN
health0.0339811641917276NN
intervention0NN
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woman0NN
education0.0101607690729067NN
social0.0169905820958638JJ
protection0NN
water0.186896403054502NN
sanitation0NN
contribute0.0554128417527413VB

Label: 4, with a score of: 0.228330091173089
WordScorePoS
evidence0NN
suggest0VB
level0.0231525547935232NN
coverage0NN
public0NN
health0NN
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woman0.0610612445035112NN
education0.244244978014045NN
social0JJ
protection0NN
water0NN
sanitation0NN
contribute0VB

Label: 1, with a score of: 0.308164875297646
WordScorePoS
evidence0NN
suggest0VB
level0.0113874611101829NN
coverage0.0908430554521382NN
public0NN
health0NN
intervention0NN
investment0.0376648791150643NN
woman0.0450489732120807NN
education0.0225244866060403NN
social0.112994637345193JJ
protection0.122839698738001NN
water0NN
sanitation0NN
contribute0VB

This recent Mexican health reform included an unprecedented effort to strengthen environmental health services regulatory actions to protect the public and more generally set of intersectoral interventions that define health policy capable of modifying the broader determinants of disease Frenk

Label: 3, with a score of: 0.751133142702181
WordScorePoS
health0.191387734041787NN
reform0NN
include0VB
effort0.0127591822694525NN
strengthen0.0150256708965218VB
environmental0JJ
service0.0100171139310145NN
action0NN
protect0.00914534810831654VB
public0.021678073222951NN
set0NN
intervention0.0407408489778079NN
policy0NN
disease0.215415047323213NN

Label: 5, with a score of: 0.370964128614065
WordScorePoS
health0.0571058915334038NN
reform0.0911713013253052NN
include0VB
effort0NN
strengthen0.0112083245137075VB
environmental0JJ
service0.022416649027415NN
action0.0409315617631NN
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public0.0727679293221751NN
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disease0NN

oral rehydration salts national vaccination days measles vaccination campaigns Universal Vaccination Program

Label: 1, with a score of: 0.877757851509671
WordScorePoS
national0.0164833460638534JJ
day0.25973846344589NN
measles0NNS
universal0JJ

Clean Water Program national health weeks

Label: 6, with a score of: 0.825884222692738
WordScorePoS
clean0.0348974218717993JJ
water0.556409482163189NN
national0JJ
health0NN

Label: 3, with a score of: 0.357635134668359
WordScorePoS
clean0.020806307400253JJ
water0.0382775468083574NN
national0.00558382296134999JJ
health0.191387734041787NN

Label: 12, with a score of: 0.3188872919498
WordScorePoS
clean0JJ
water0.186896403054502NN
national0.00743561777158133JJ
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Label: 7, with a score of: 0.174633542023962
WordScorePoS
clean0.125032076213024JJ
water0NN
national0JJ
health0NN

Progresa

Label: 0, with a score of: 1

Arranque Parejo en la Vida

Label: 0, with a score of: 1

mortality rate per live births Mortality in Children under Five Years under One Year and Neonates Mexico year under years under year neonatal Sources Data from the Mexican Ministry of Health Epidemiological and Statistical Mortality System and the Mexican National Council on Population

Label: 3, with a score of: 0.892217043842741
WordScorePoS
mortality0.276962203701274NN
rate0.0433561464459019NN
live0.0300513417930436VB
birth0.0748292956291867NN
child0.10682408961305NN
neonatal0.0407408489778079JJ
source0NN
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health0.191387734041787NN
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national0.00558382296134999JJ
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APPROACHES TO ENVIRONMENTAL HEALTH illustrate the opportunities that exist to include or supplement environmental health activities and hygiene promotion in these programs

Label: 3, with a score of: 0.563978289803779
WordScorePoS
approach0NN
environmental0JJ
health0.191387734041787NN
opportunity0NN
exist0VB
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activity0NN
hygiene0NN
promotion0NN

Label: 6, with a score of: 0.297980075561486
WordScorePoS
approach0NN
environmental0JJ
health0NN
opportunity0.0153390539205676NN
exist0VB
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activity0.0502364757923669NN
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promotion0NN

Label: 12, with a score of: 0.434688693554344
WordScorePoS
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
opportunity0NN
exist0.0332151194779746VB
include0VB
activity0.0199423462679015NN
hygiene0NN
promotion0NN

Label: 5, with a score of: 0.335638291332848
WordScorePoS
approach0NN
environmental0JJ
health0.0571058915334038NN
opportunity0.02046578088155NN
exist0VB
include0VB
activity0NN
hygiene0NN
promotion0.0931221694711702NN

Nutrition projects in developing countries also require complementary investments in water and sanitation without these children may lose the benefits of additional food intake to parasite infestation and diarrhea Horton

Label: 6, with a score of: 0.722777999224713
WordScorePoS
nutrition0NN
project0.041835863322702NN
develop0VB
country0NN
require0VB
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water0.556409482163189NN
sanitation0.334686906581616NN
child0.0255958462813622NN
lose0VB
benefit0NN
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food0.0214003646985842NN
intake0NN

Label: 2, with a score of: 0.482090531851505
WordScorePoS
nutrition0.175025014152344NN
project0NN
develop0VB
country0NN
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investment0.0182713919265625NN
water0NN
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child0.0546336178945768NN
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additional0.0440683498519077JJ
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Label: 12, with a score of: 0.359269112606323
WordScorePoS
nutrition0NN
project0.0664302389559493NN
develop0VB
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water0.186896403054502NN
sanitation0NN
child0NN
lose0VB
benefit0NN
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food0.186896403054502NN
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A review of health reforms in Central America found that programs addressing malnutrition should focus on preventive measures such as ensuring access to safe water and sanitation educating mothers about nutrition hygiene and health practices using growth monitoring to ensure early detection of malnutrition and establishing links with health care specialists for at risk populations including the rural indigenous World Bank

Label: 6, with a score of: 0.564073173483852
WordScorePoS
review0NN
health0NN
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central0JJ
address0NN
malnutrition0.041835863322702NN
focus0NN
measure0NN
ensure0.00936547854413134VB
access0.00731085509381114NN
safe0.0428007293971684JJ
water0.556409482163189NN
sanitation0.334686906581616NN
educate0VB
mother0NN
nutrition0NN
hygiene0.136665345449673NN
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growth0NN
monitor0NN
establish0VB
care0NN
risk0NN
population0.0363595928905615NN
include0VB
rural0JJ
indigenous0JJ
world0.00438651305628668NN
bank0NN

Label: 3, with a score of: 0.485987896177677
WordScorePoS
review0NN
health0.191387734041787NN
reform0NN
central0JJ
address0NN
malnutrition0NN
focus0NN
measure0NN
ensure0.00837573444202498VB
access0.00610236075888593NN
safe0.0127591822694525JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
educate0.0407408489778079VB
mother0.162963395911232NN
nutrition0NN
hygiene0NN
practice0NN
growth0NN
monitor0NN
establish0VB
care0.104031537001265NN
risk0.0703902516159815NN
population0NN
include0VB
rural0JJ
indigenous0JJ
world0.00087176582269799NN
bank0NN

Label: 2, with a score of: 0.365248524541803
WordScorePoS
review0NN
health0NN
reform0NN
central0.0440683498519077JJ
address0NN
malnutrition0.0357189919948307NN
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measure0.0504000902222448NN
ensure0.0159922815774215VB
access0.00749031153171887NN
safe0.0182713919265625JJ
water0NN
sanitation0NN
educate0VB
mother0NN
nutrition0.175025014152344NN
hygiene0NN
practice0.0252000451111224NN
growth0.0252000451111224NN
monitor0NN
establish0VB
care0NN
risk0.0252000451111224NN
population0.0310434135749871NN
include0VB
rural0.148975141598503JJ
indigenous0.0357189919948307JJ
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 12, with a score of: 0.198011401872219
WordScorePoS
review0NN
health0.0339811641917276NN
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malnutrition0NN
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ensure0.00743561777158133VB
access0.00232174891244877NN
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water0.186896403054502NN
sanitation0NN
educate0VB
mother0NN
nutrition0NN
hygiene0NN
practice0.0703006268489394NN
growth0NN
monitor0.0332151194779746NN
establish0VB
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risk0NN
population0.0144336476662975NN
include0VB
rural0JJ
indigenous0JJ
world0.00464349782489754NN
bank0NN

Label: 8, with a score of: 0.165207470845782
WordScorePoS
review0NN
health0NN
reform0NN
central0JJ
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malnutrition0NN
focus0.0410992516792148NN
measure0.0347609334428716NN
ensure0VB
access0.00344404437204141NN
safe0.0252035516550537JJ
water0NN
sanitation0NN
educate0VB
mother0NN
nutrition0NN
hygiene0NN
practice0NN
growth0.208565600657229NN
monitor0NN
establish0VB
care0NN
risk0NN
population0.0428212738652355NN
include0VB
rural0JJ
indigenous0JJ
world0.00172202218602071NN
bank0NN

An analysis of India main child survival program concluded that even with improvements in the Integrated Child Development Services the country will not meet the Millennium Development Goals in nutrition without investing more in indirect interventions such as water and sanitation infrastructure and women education Gragnolati and others

Label: 6, with a score of: 0.629310899622654
WordScorePoS
child0.0255958462813622NN
improvement0NN
integrate0.0251182378961834VB
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service0.0084006124696649NN
country0NN
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millennium0JJ
goal0NN
nutrition0NN
invest0VB
intervention0NN
water0.556409482163189NN
sanitation0.334686906581616NN
infrastructure0.0181797964452808NN
woman0.0127979231406811NN
education0NN

Label: 2, with a score of: 0.342072821668341
WordScorePoS
child0.0546336178945768NN
improvement0NN
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development0.0159922815774215NN
service0.0143446978608332NN
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nutrition0.175025014152344NN
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infrastructure0.0155217067874935NN
woman0.0546336178945768NN
education0NN

Label: 4, with a score of: 0.321170262942575
WordScorePoS
child0.076326555629389NN
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development0.0279277626235394NN
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water0NN
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woman0.0610612445035112NN
education0.244244978014045NN

Label: 5, with a score of: 0.293902493052542
WordScorePoS
child0.0170753354211044NN
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goal0NN
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sanitation0NN
infrastructure0.024255976440725NN
woman0.221979360474357NN
education0.0512260062633133NN

Label: 9, with a score of: 0.282822913957751
WordScorePoS
child0NN
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country0NN
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nutrition0NN
invest0VB
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water0.0377086395700813NN
sanitation0.0737171311497939NN
infrastructure0.192202909044225NN
woman0NN
education0.022550656390892NN

Label: 12, with a score of: 0.185739614103353
WordScorePoS
child0NN
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development0.022306853314744NN
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country0NN
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goal0NN
nutrition0NN
invest0VB
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water0.186896403054502NN
sanitation0NN
infrastructure0.028867295332595NN
woman0NN
education0.0101607690729067NN

In the late Thailand nutrition program was able to effectively address malnutrition by adopting more integrated approach see box

Label: 2, with a score of: 0.80648919057231
WordScorePoS
nutrition0.175025014152344NN
effectively0RB
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In Ghana the Community Based Poverty Reduction Project US

Label: 1, with a score of: 0.762292928629276
WordScorePoS
community0NN
base0.0442083771593746NN
poverty0.269969049497485NN
reduction0NN
project0NN

Label: 12, with a score of: 0.328726135854922
WordScorePoS
community0.0169905820958638NN
base0.0199423462679015NN
poverty0.0121782716594324NN
reduction0.0199423462679015NN
project0.0664302389559493NN

Label: 10, with a score of: 0.30551925561095
WordScorePoS
community0.0202620733250388NN
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poverty0.05809266143877NN
reduction0.0475643836183697NN
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million used an integrated community based approach for basic health and nutrition service delivery

Label: 3, with a score of: 0.459085811008159
WordScorePoS
integrate0VB
community0NN
base0.0149758277542848NN
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basic0JJ
health0.191387734041787NN
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service0.0100171139310145NN

Label: 2, with a score of: 0.44054342782918
WordScorePoS
integrate0VB
community0.0182713919265625NN
base0NN
approach0NN
basic0JJ
health0NN
nutrition0.175025014152344NN
service0.0143446978608332NN

Label: 12, with a score of: 0.352644242616756
WordScorePoS
integrate0.0199423462679015VB
community0.0169905820958638NN
base0.0199423462679015NN
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health0.0339811641917276NN
nutrition0NN
service0.00666957305782837NN

Label: 11, with a score of: 0.34376087537653
WordScorePoS
integrate0.0537696560159885VB
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service0.0269743071558856NN

Label: 1, with a score of: 0.323674168565983
WordScorePoS
integrate0VB
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In addition to monitoring child growth promoting pre and BOX

Label: 8, with a score of: 0.657057153124415
WordScorePoS
addition0NN
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child0.0452169560888236NN
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Label: 10, with a score of: 0.430852959559436
WordScorePoS
addition0NN
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child0.0242343960710022NN
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promote0.00886732612541978VB

Thailand National Nutrition Program Thailand National Nutrition Program successfully reduced moderate malnutrition from about percent in the under five population in to about percent in

Label: 2, with a score of: 0.866703232966623
WordScorePoS
national0.00399807039435538JJ
nutrition0.175025014152344NN
reduce0.00799614078871077VB
malnutrition0.0357189919948307NN
population0.0310434135749871NN

Although the health sector led the nutrition program outreach into villages the fundamental assumption was that malnutrition was symptom of poverty and therefore that multisectoral attack on poverty was needed to deal with malnutrition

Label: 1, with a score of: 0.766056307446084
WordScorePoS
health0NN
sector0NN
lead0NN
nutrition0NN
fundamental0JJ
malnutrition0.0736315832425121NN
poverty0.269969049497485NN

Label: 2, with a score of: 0.393326196419967
WordScorePoS
health0NN
sector0.0182713919265625NN
lead0NN
nutrition0.175025014152344NN
fundamental0.0357189919948307JJ
malnutrition0.0357189919948307NN
poverty0.0261926252110933NN

Label: 3, with a score of: 0.26218518095968
WordScorePoS
health0.191387734041787NN
sector0NN
lead0.025518364538905NN
nutrition0NN
fundamental0JJ
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poverty0.00914534810831654NN

Accordingly the Rural Development Plan and the Poverty Alleviation Program supplemented the nutrition program by funding wide range of programs including the following Basic primary health and nutrition services Latrines and clean water literacy program Agricultural production projects Village development projects such as creation of fishponds or development of water sources Employment schemes during the dry season in disadvantaged nonirrigated areas Source Heaver and Kachondam

Label: 6, with a score of: 0.629188175205898
WordScorePoS
rural0JJ
development0NN
plan0NN
poverty0NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0.0181797964452808JJ
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latrine0.0683326727248364NN
clean0.0348974218717993JJ
water0.556409482163189NN
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project0.041835863322702NN
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source0.0613562156822703NN
employment0NN
disadvantaged0JJ

Label: 2, with a score of: 0.410483540996744
WordScorePoS
rural0.148975141598503JJ
development0.0159922815774215NN
plan0NN
poverty0.0261926252110933NN
nutrition0.175025014152344NN
wide0JJ
range0NN
include0VB
basic0JJ
primary0.0155217067874935JJ
health0NN
service0.0143446978608332NN
latrine0NN
clean0JJ
water0NN
literacy0NN
agricultural0.250032943963815JJ
production0.0548141757796873NN
project0NN
creation0NN
source0.0130963126055467NN
employment0.0252000451111224NN
disadvantaged0JJ

Label: 12, with a score of: 0.331280949012271
WordScorePoS
rural0JJ
development0.022306853314744NN
plan0.0144336476662975NN
poverty0.0121782716594324NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0.0144336476662975JJ
primary0JJ
health0.0339811641917276NN
service0.00666957305782837NN
latrine0NN
clean0JJ
water0.186896403054502NN
literacy0NN
agricultural0JJ
production0.118934074671047NN
project0.0664302389559493NN
creation0NN
source0NN
employment0NN
disadvantaged0JJ

Label: 4, with a score of: 0.22049773676612
WordScorePoS
rural0JJ
development0.0279277626235394NN
plan0NN
poverty0NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0.0433695758119029JJ
primary0.108423939529757JJ
health0NN
service0NN
latrine0NN
clean0JJ
water0NN
literacy0.244520809605025NN
agricultural0JJ
production0NN
project0NN
creation0NN
source0NN
employment0.0352060273355634NN
disadvantaged0JJ

Label: 8, with a score of: 0.22043946029668
WordScorePoS
rural0JJ
development0.0055149369084567NN
plan0NN
poverty0.0722601961736204NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0.0214106369326177JJ
primary0JJ
health0NN
service0.0197870712294258NN
latrine0NN
clean0JJ
water0NN
literacy0NN
agricultural0JJ
production0.0504071033101074NN
project0NN
creation0.160952962344818NN
source0NN
employment0.173804667214358NN
disadvantaged0JJ

Label: 1, with a score of: 0.206145184426334
WordScorePoS
rural0JJ
development0.0164833460638534NN
plan0NN
poverty0.269969049497485NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0.0639932865717261JJ
primary0JJ
health0NN
service0.0443555132287109NN
latrine0NN
clean0JJ
water0NN
literacy0NN
agricultural0JJ
production0NN
project0NN
creation0NN
source0.0269969049497485NN
employment0NN
disadvantaged0JJ

Label: 3, with a score of: 0.180261975183209
WordScorePoS
rural0JJ
development0.00837573444202498NN
plan0.021678073222951NN
poverty0.00914534810831654NN
nutrition0NN
wide0.0307735781890304JJ
range0.0249430985430622NN
include0VB
basic0JJ
primary0.0108390366114755JJ
health0.191387734041787NN
service0.0100171139310145NN
latrine0NN
clean0.020806307400253JJ
water0.0382775468083574NN
literacy0NN
agricultural0JJ
production0NN
project0NN
creation0NN
source0NN
employment0NN
disadvantaged0JJ

Label: 7, with a score of: 0.112740080416178
WordScorePoS
rural0JJ
development0NN
plan0NN
poverty0NN
nutrition0NN
wide0JJ
range0NN
include0VB
basic0JJ
primary0JJ
health0NN
service0.0451471467893167NN
latrine0NN
clean0.125032076213024JJ
water0NN
literacy0NN
agricultural0JJ
production0.0383371018038178NN
project0NN
creation0NN
source0.0274787313211514NN
employment0NN
disadvantaged0JJ

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL postnatal care and family planning and immunizing children community workers advised on environmental sanitation and hygiene World Bank

Label: 3, with a score of: 0.561300886471061
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
care0.104031537001265NN
family0.0624189222007589NN
plan0.021678073222951NN
community0NN
worker0NN
sanitation0.0249430985430622NN
hygiene0NN
world0.00087176582269799NN
bank0NN

Label: 6, with a score of: 0.528881216506292
WordScorePoS
environmental0JJ
health0NN
child0.0255958462813622NN
care0NN
family0.0348974218717993NN
plan0NN
community0.0214003646985842NN
worker0NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
world0.00438651305628668NN
bank0NN

An evaluation of programs in Ecuador Sistema Integral de Alimentación Nutrición suggested that nutritional programs in rural areas be complemented with improved water and sanitation community based growth promotion improved health service access and nutritional supplements for pregnant mothers and young children among other interventions

Label: 6, with a score of: 0.698550258080286
WordScorePoS
integral0JJ
suggest0VB
nutritional0JJ
rural0JJ
complement0NN
improve0.0511916925627245VB
water0.556409482163189NN
sanitation0.334686906581616NN
community0.0214003646985842NN
base0NN
growth0NN
promotion0NN
health0NN
service0.0084006124696649NN
access0.00731085509381114NN
pregnant0JJ
mother0NN
child0.0255958462813622NN
intervention0NN

Label: 3, with a score of: 0.394341012040868
WordScorePoS
integral0JJ
suggest0VB
nutritional0JJ
rural0JJ
complement0NN
improve0VB
water0.0382775468083574NN
sanitation0.0249430985430622NN
community0NN
base0.0149758277542848NN
growth0NN
promotion0NN
health0.191387734041787NN
service0.0100171139310145NN
access0.00610236075888593NN
pregnant0JJ
mother0.162963395911232NN
child0.10682408961305NN
intervention0.0407408489778079NN

Label: 2, with a score of: 0.322524204232588
WordScorePoS
integral0JJ
suggest0VB
nutritional0.0583416713841148JJ
rural0.148975141598503JJ
complement0NN
improve0.0218534471578307VB
water0NN
sanitation0NN
community0.0182713919265625NN
base0NN
growth0.0252000451111224NN
promotion0NN
health0NN
service0.0143446978608332NN
access0.00749031153171887NN
pregnant0.0583416713841148JJ
mother0NN
child0.0546336178945768NN
intervention0NN

Label: 8, with a score of: 0.203150980491284
WordScorePoS
integral0JJ
suggest0VB
nutritional0JJ
rural0JJ
complement0NN
improve0.0150723186962745VB
water0NN
sanitation0NN
community0NN
base0NN
growth0.208565600657229NN
promotion0NN
health0NN
service0.0197870712294258NN
access0.00344404437204141NN
pregnant0JJ
mother0NN
child0.0452169560888236NN
intervention0NN

Label: 12, with a score of: 0.176459659789625
WordScorePoS
integral0JJ
suggest0VB
nutritional0JJ
rural0JJ
complement0NN
improve0VB
water0.186896403054502NN
sanitation0NN
community0.0169905820958638NN
base0.0199423462679015NN
growth0NN
promotion0NN
health0.0339811641917276NN
service0.00666957305782837NN
access0.00232174891244877NN
pregnant0JJ
mother0NN
child0NN
intervention0NN

The study recommended that at the national level programs should include behavior change communications programs and work closely with the authorities responsible for water and sanitation World Bank

Label: 6, with a score of: 0.811434858700918
WordScorePoS
study0NN
recommend0VB
national0JJ
level0.00647010760354177NN
include0VB
change0NN
communication0NN
responsible0JJ
water0.556409482163189NN
sanitation0.334686906581616NN
world0.00438651305628668NN
bank0NN

Label: 13, with a score of: 0.412830870843968
WordScorePoS
study0NN
recommend0VB
national0.0112708859309299JJ
level0.0415277415054218NN
include0VB
change0.402565546215053NN
communication0NN
responsible0JJ
water0NN
sanitation0NN
world0.00351929966767313NN
bank0NN

Label: 12, with a score of: 0.183628088859208
WordScorePoS
study0NN
recommend0VB
national0.00743561777158133JJ
level0.00513687014008325NN
include0VB
change0NN
communication0NN
responsible0JJ
water0.186896403054502NN
sanitation0NN
world0.00464349782489754NN
bank0NN

Infrastructure Programs Development is often seen as synonymous with improvements in infrastructure and accordingly donor funding and government investments have been geared toward improving access to water supply expanding coverage for sanitation and sewerage and extending rural electrification

Label: 6, with a score of: 0.747487561817752
WordScorePoS
infrastructure0.0181797964452808NN
development0NN
improvement0NN
government0NN
investment0NN
improve0.0511916925627245VB
access0.00731085509381114NN
water0.556409482163189NN
supply0.0590310971343993NN
expand0.0251182378961834VB
coverage0NN
sanitation0.334686906581616NN
extend0VB
rural0JJ

Label: 9, with a score of: 0.436503863218541
WordScorePoS
infrastructure0.192202909044225NN
development0.0330049940546426NN
improvement0.0454743001434393NN
government0NN
investment0.0377086395700813NN
improve0VB
access0.0128821355880844NN
water0.0377086395700813NN
supply0NN
expand0VB
coverage0NN
sanitation0.0737171311497939NN
extend0VB
rural0JJ

Label: 12, with a score of: 0.23718827932233
WordScorePoS
infrastructure0.028867295332595NN
development0.022306853314744NN
improvement0NN
government0NN
investment0NN
improve0VB
access0.00232174891244877NN
water0.186896403054502NN
supply0.0703006268489394NN
expand0VB
coverage0NN
sanitation0NN
extend0VB
rural0JJ

Label: 2, with a score of: 0.170176672243892
WordScorePoS
infrastructure0.0155217067874935NN
development0.0159922815774215NN
improvement0NN
government0NN
investment0.0182713919265625NN
improve0.0218534471578307VB
access0.00749031153171887NN
water0NN
supply0NN
expand0VB
coverage0NN
sanitation0NN
extend0VB
rural0.148975141598503JJ

The result has been improvements in the access and coverage indicators for these environmental services

Label: 1, with a score of: 0.602614248364295
WordScorePoS
result0NN
improvement0NN
access0.00514687440545096NN
coverage0.0908430554521382NN
environmental0.0442083771593746JJ
service0.0443555132287109NN

Label: 7, with a score of: 0.500653243396028
WordScorePoS
result0NN
improvement0.0924643738905717NN
access0.0157161992303584NN
coverage0NN
environmental0JJ
service0.0451471467893167NN

Label: 9, with a score of: 0.311141221691563
WordScorePoS
result0NN
improvement0.0454743001434393NN
access0.0128821355880844NN
coverage0NN
environmental0.0221298700466866JJ
service0.0148023490369527NN

Despite these improvements in infrastructure however the trends in the incidence of diarrhea have not fallen correspondingly in developing countries Kosek Bern and Guerrant

Label: 9, with a score of: 0.70387316688415
WordScorePoS
improvement0.0454743001434393NN
infrastructure0.192202909044225NN
incidence0NN
fall0NN
develop0VB
country0NN

Label: 3, with a score of: 0.485192394048959
WordScorePoS
improvement0NN
infrastructure0NN
incidence0.0407408489778079NN
fall0.123094312756122NN
develop0VB
country0NN

Label: 7, with a score of: 0.466726513649102
WordScorePoS
improvement0.0924643738905717NN
infrastructure0.0651354046449052NN
incidence0NN
fall0NN
develop0VB
country0NN

Over the years donor agencies and country governments have increasingly realized that simply providing new infrastructure be it latrines piped water systems or improved cookstoves is not the magic bullet for achieving improved health

Label: 6, with a score of: 0.760054630154446
WordScorePoS
agency0NN
country0NN
government0NN
realize0VB
provide0VB
infrastructure0.0181797964452808NN
latrine0.0683326727248364NN
water0.556409482163189NN
system0NN
improve0.0511916925627245VB
achieve0.0194103228106253VB
health0NN

Label: 12, with a score of: 0.337347379286288
WordScorePoS
agency0.0542519672965169NN
country0NN
government0NN
realize0VB
provide0.0200087191734851VB
infrastructure0.028867295332595NN
latrine0NN
water0.186896403054502NN
system0NN
improve0VB
achieve0.0154106104202498VB
health0.0339811641917276NN

Label: 9, with a score of: 0.284676279117988
WordScorePoS
agency0NN
country0NN
government0NN
realize0VB
provide0.00740117451847634VB
infrastructure0.192202909044225NN
latrine0NN
water0.0377086395700813NN
system0NN
improve0VB
achieve0.0114006914853063VB
health0.0377086395700813NN

Label: 3, with a score of: 0.242055555238616
WordScorePoS
agency0NN
country0NN
government0NN
realize0VB
provide0.0100171139310145VB
infrastructure0NN
latrine0NN
water0.0382775468083574NN
system0NN
improve0VB
achieve0.00385756426954823VB
health0.191387734041787NN

Elements of behavior change the so called software are critical part of the equation

Label: 13, with a score of: 0.934968879786323
WordScorePoS
change0.402565546215053NN
critical0JJ

For example Peru national government expressed interest in piloting hand washing campaign after US billion of investments in water supply infrastructure failed to significantly reduce the prevalence of water related diseases Public Private Partnership for Handwashing with Soap

Label: 6, with a score of: 0.780719438876849
WordScorePoS
national0JJ
government0NN
investment0NN
water0.556409482163189NN
supply0.0590310971343993NN
infrastructure0.0181797964452808NN
significantly0RB
reduce0.00936547854413134VB
prevalence0NN
related0.0524959536790166JJ
disease0.103230094596636NN
public0NN
private0JJ
partnership0NN

Label: 17, with a score of: 0.389309834234129
WordScorePoS
national0.0134132459226336JJ
government0.048933054487825NN
investment0.0766240489430275NN
water0NN
supply0NN
infrastructure0.0130185595639838NN
significantly0RB
reduce0.00335331148065841VB
prevalence0NN
related0JJ
disease0NN
public0.0390556786919513NN
private0.0898760357768464JJ
partnership0.3914644359026NN

Label: 12, with a score of: 0.311053517870667
WordScorePoS
national0.00743561777158133JJ
government0NN
investment0NN
water0.186896403054502NN
supply0.0703006268489394NN
infrastructure0.028867295332595NN
significantly0RB
reduce0.022306853314744VB
prevalence0NN
related0.00833571598658786JJ
disease0NN
public0.028867295332595NN
private0JJ
partnership0NN

Label: 3, with a score of: 0.224253161976252
WordScorePoS
national0.00558382296134999JJ
government0NN
investment0NN
water0.0382775468083574NN
supply0NN
infrastructure0NN
significantly0RB
reduce0.01675146888405VB
prevalence0.0407408489778079NN
related0.0125195145191824JJ
disease0.215415047323213NN
public0.021678073222951NN
private0JJ
partnership0NN

Label: 9, with a score of: 0.214076567673525
WordScorePoS
national0.00412562425683033JJ
government0NN
investment0.0377086395700813NN
water0.0377086395700813NN
supply0NN
infrastructure0.192202909044225NN
significantly0RB
reduce0VB
prevalence0NN
related0.00925008066007716JJ
disease0NN
public0.0160169090870187NN
private0.0368585655748969JJ
partnership0NN

These behaviors ranging from hand washing practices to proper feces disposal to ventilation practices are what make the difference between simply having access and actually improving health

Label: 3, with a score of: 0.559651193500235
WordScorePoS
range0.0249430985430622NN
practice0NN
proper0JJ
access0.00610236075888593NN
improve0VB
health0.191387734041787NN

One program that has brought together elements of infrastructure and behavior change has been the Total Sanitation Campaign in rural Bangladesh

Label: 13, with a score of: 0.541195430069064
WordScorePoS
bring0VB
infrastructure0NN
change0.402565546215053NN
total0NN
sanitation0NN
rural0JJ

Label: 6, with a score of: 0.514061695164776
WordScorePoS
bring0VB
infrastructure0.0181797964452808NN
change0NN
total0.0295155485671997NN
sanitation0.334686906581616NN
rural0JJ

Label: 9, with a score of: 0.392452783912702
WordScorePoS
bring0VB
infrastructure0.192202909044225NN
change0NN
total0.0260040237236563NN
sanitation0.0737171311497939NN
rural0JJ

Label: 2, with a score of: 0.35665630346135
WordScorePoS
bring0VB
infrastructure0.0155217067874935NN
change0.0756001353333673NN
total0.0252000451111224NN
sanitation0NN
rural0.148975141598503JJ

Label: 7, with a score of: 0.300815182442557
WordScorePoS
bring0VB
infrastructure0.0651354046449052NN
change0.105749654845006NN
total0.0528748274225028NN
sanitation0NN
rural0JJ

This comprehensive program has been successful in eradicating the practice of open defecation by promoting behavior change and sanitation facilities in rural areas

Label: 13, with a score of: 0.588130727072261
WordScorePoS
successful0JJ
eradicate0VB
practice0NN
defecation0NN
promote0.00375696197697663VB
change0.402565546215053NN
sanitation0NN
facility0NN
rural0JJ

Label: 6, with a score of: 0.583349909057561
WordScorePoS
successful0JJ
eradicate0VB
practice0NN
defecation0.0683326727248364NN
promote0VB
change0NN
sanitation0.334686906581616NN
facility0NN
rural0JJ

Label: 2, with a score of: 0.373110804341762
WordScorePoS
successful0JJ
eradicate0VB
practice0.0252000451111224NN
defecation0NN
promote0.00799614078871077VB
change0.0756001353333673NN
sanitation0NN
facility0NN
rural0.148975141598503JJ

Going beyond providing affordable sanitation options in terms of technologies and costs this program as well as some similar programs has been effective in ensuring high toilet use through combination of participatory processes hygiene promotion institutional incentives such as financial rewards for achieving universal toilet coverage and community bans on practices such as open defecation WSP

Label: 6, with a score of: 0.612440648524612
WordScorePoS
provide0VB
affordable0.0214003646985842JJ
sanitation0.334686906581616NN
term0NN
technology0.0153390539205676NN
cost0NN
effective0JJ
ensure0.00936547854413134VB
toilet0.0683326727248364NN
participatory0JJ
process0NN
hygiene0.136665345449673NN
promotion0NN
institutional0JJ
incentive0NN
financial0JJ
achieve0.0194103228106253VB
universal0.0153390539205676JJ
coverage0NN
community0.0214003646985842NN
ban0NN
practice0NN
defecation0.0683326727248364NN

Label: 17, with a score of: 0.330792705135448
WordScorePoS
provide0.00601568197638796VB
affordable0JJ
sanitation0NN
term0.149793392961411NN
technology0.109843026967392NN
cost0NN
effective0.0219686053934784JJ
ensure0.00335331148065841VB
toilet0NN
participatory0JJ
process0NN
hygiene0NN
promotion0.0249900578719309NN
institutional0.036961556179878JJ
incentive0.036961556179878NN
financial0.0150369494376999JJ
achieve0.00463324666343875VB
universal0.0109843026967392JJ
coverage0NN
community0NN
ban0NN
practice0NN
defecation0NN

Label: 7, with a score of: 0.365032556085251
WordScorePoS
provide0VB
affordable0.0766742036076356JJ
sanitation0NN
term0.0749457204978913NN
technology0.109914925284606NN
cost0NN
effective0JJ
ensure0.0251662980592747VB
toilet0NN
participatory0JJ
process0NN
hygiene0NN
promotion0NN
institutional0JJ
incentive0NN
financial0JJ
achieve0VB
universal0.0549574626423028JJ
coverage0NN
community0NN
ban0.122412709674631NN
practice0NN
defecation0NN

The Total Sanitation Campaign has seen more APPROACHES TO ENVIRONMENTAL HEALTH than villages achieve percent sanitation coverage without household subsidy for infrastructure WSP

Label: 6, with a score of: 0.711143806321572
WordScorePoS
total0.0295155485671997NN
sanitation0.334686906581616NN
approach0NN
environmental0JJ
health0NN
achieve0.0194103228106253VB
coverage0NN
household0NN
subsidy0NN
infrastructure0.0181797964452808NN

Label: 9, with a score of: 0.421851247536724
WordScorePoS
total0.0260040237236563NN
sanitation0.0737171311497939NN
approach0NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
achieve0.0114006914853063VB
coverage0NN
household0NN
subsidy0NN
infrastructure0.192202909044225NN

Label: 3, with a score of: 0.266413646651712
WordScorePoS
total0NN
sanitation0.0249430985430622NN
approach0NN
environmental0JJ
health0.191387734041787NN
achieve0.00385756426954823VB
coverage0.0307735781890304NN
household0NN
subsidy0NN
infrastructure0NN

Label: 14, with a score of: 0.178199219790488
WordScorePoS
total0NN
sanitation0NN
approach0NN
environmental0JJ
health0.0166605993001162NN
achieve0.00503710435450552VB
coverage0NN
household0NN
subsidy0.162850158165781NN
infrastructure0NN

Label: 12, with a score of: 0.348627799180167
WordScorePoS
total0.0468670845659596NN
sanitation0NN
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
achieve0.0154106104202498VB
coverage0NN
household0.0554128417527413NN
subsidy0.0664302389559493NN
infrastructure0.028867295332595NN

With the widely regaled success of the Bangladesh story Total Sanitation Campaigns began to spread to Ethiopia India Nigeria and Pakistan

Label: 6, with a score of: 0.932536938643456
WordScorePoS
widely0RB
total0.0295155485671997NN
sanitation0.334686906581616NN
spread0NN

The Ethiopian story was an equally successful one with strong multisectoral approach at the local level that emphasized education and community participation see box

Label: 4, with a score of: 0.65624232492117
WordScorePoS
successful0JJ
strong0JJ
approach0NN
local0JJ
level0.0231525547935232NN
education0.244244978014045NN
community0NN
participation0NN

The effectiveness of the campaign varied across different states in India

Label: 0, with a score of: 1

Although these programs were meant to be based on the same principles of community involvement and attention to hygiene and social intermediation review showed that excessive attention to coverage targets overshadowed the goals of improved community health

Label: 6, with a score of: 0.418285844144112
WordScorePoS
base0NN
principle0NN
community0.0214003646985842NN
attention0.041835863322702NN
hygiene0.136665345449673NN
social0JJ
review0NN
excessive0JJ
coverage0NN
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improve0.0511916925627245VB
health0NN

Label: 3, with a score of: 0.315564115530446
WordScorePoS
base0.0149758277542848NN
principle0NN
community0NN
attention0NN
hygiene0NN
social0JJ
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coverage0.0307735781890304NN
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improve0VB
health0.191387734041787NN

Label: 10, with a score of: 0.494279274577238
WordScorePoS
base0NN
principle0.0977392570420122NN
community0.0202620733250388NN
attention0.0396106020715138NN
hygiene0NN
social0.101310366625194JJ
review0NN
excessive0JJ
coverage0NN
target0NN
goal0NN
improve0.0121171980355011VB
health0.0405241466500776NN

Label: 1, with a score of: 0.330080891932864
WordScorePoS
base0.0442083771593746NN
principle0NN
community0NN
attention0NN
hygiene0NN
social0.112994637345193JJ
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excessive0JJ
coverage0.0908430554521382NN
target0NN
goal0NN
improve0VB
health0NN

Surveys of some villages showed that although they had percent latrine coverage several households were in fact using the latrines to store rice WSP

Label: 0, with a score of: 1

With rural populations still largely dependent on biomass fuels for cooking and heating and the consequent health impacts from indoor air pollution country governments donor agencies and nongovernmental organizations NGOs have been working to help rural populations move up the energy ladder toward improved cookstoves and cleaner fuels for example liquefied petroleum gas

Label: 7, with a score of: 0.741599385960955
WordScorePoS
rural0JJ
population0NN
fuel0.0749457204978913NN
cooking0.122412709674631NN
heating0.122412709674631NN
health0NN
impact0NN
air0NN
pollution0NN
country0NN
government0NN
agency0NN
organization0NN
move0NN
energy0.494617163780726NN
improve0.0229264916384433VB
cleaner0.0924643738905717JJR
gas0.0749457204978913NN

Label: 12, with a score of: 0.382681907461268
WordScorePoS
rural0JJ
population0.0144336476662975NN
fuel0.0332151194779746NN
cooking0NN
heating0NN
health0.0339811641917276NN
impact0.0866018859977851NN
air0.0554128417527413NN
pollution0.0234335422829798NN
country0NN
government0NN
agency0.0542519672965169NN
organization0NN
move0.0409791940864438NN
energy0.133960988253756NN
improve0VB
cleaner0JJR
gas0.0332151194779746NN

Label: 2, with a score of: 0.271306838939571
WordScorePoS
rural0.148975141598503JJ
population0.0310434135749871NN
fuel0NN
cooking0NN
heating0NN
health0NN
impact0NN
air0NN
pollution0NN
country0NN
government0NN
agency0NN
organization0NN
move0NN
energy0.0130963126055467NN
improve0.0218534471578307VB
cleaner0JJR
gas0NN

Label: 3, with a score of: 0.169925579895216
WordScorePoS
rural0JJ
population0NN
fuel0NN
cooking0NN
heating0NN
health0.191387734041787NN
impact0NN
air0.020806307400253NN
pollution0.0175975629039954NN
country0NN
government0NN
agency0NN
organization0.0175975629039954NN
move0NN
energy0NN
improve0VB
cleaner0JJR
gas0NN

Although considerations of energy efficiency and costs have dominated rural energy technology choices recent studies have pointed out the need to pay attention to changes in behavior

Label: 7, with a score of: 0.875644423957347
WordScorePoS
energy0.494617163780726NN
efficiency0.134992154141495NN
cost0NN
rural0JJ
technology0.109914925284606NN
choice0NN
study0NN
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Label: 12, with a score of: 0.267127711043778
WordScorePoS
energy0.133960988253756NN
efficiency0.039884692535803NN
cost0.0277064208763707NN
rural0JJ
technology0NN
choice0.0409791940864438NN
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Label: 2, with a score of: 0.133576582422371
WordScorePoS
energy0.0130963126055467NN
efficiency0NN
cost0NN
rural0.148975141598503JJ
technology0.0130963126055467NN
choice0NN
study0NN
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A research study in Bangladesh for example suggested changes in cooking arrangements and location construction materials BOX

Label: 7, with a score of: 0.662745498560266
WordScorePoS
research0.0528748274225028NN
study0NN
suggest0VB
cooking0.122412709674631NN
location0NN
material0NN

Label: 9, with a score of: 0.620896755427336
WordScorePoS
research0.104016094894625NN
study0NN
suggest0.0602029956716497VB
cooking0NN
location0NN
material0NN

Ethiopia The Toilet Revolution Another example that drew from the Total Sanitation Campaign is in the Southern Nations Region of Ethiopia

Label: 6, with a score of: 0.755483854651095
WordScorePoS
toilet0.0683326727248364NN
total0.0295155485671997NN
sanitation0.334686906581616NN
southern0JJ
nation0NN
region0NN

Label: 1, with a score of: 0.429113859782845
WordScorePoS
toilet0NN
total0NN
sanitation0NN
southern0.0614198493690006JJ
nation0NN
region0.184259548107002NN

Label: 3, with a score of: 0.334295952958721
WordScorePoS
toilet0NN
total0NN
sanitation0.0249430985430622NN
southern0.0416126148005059JJ
nation0NN
region0.124837844401518NN

The Regional Health Bureau with support from the regional cabinet shifted from broad primary health care model to focus on preventable diseases through limited number of highimpact broad reach low cost public health interventions in rural areas

Label: 3, with a score of: 0.767113269393927
WordScorePoS
regional0JJ
health0.191387734041787NN
support0.00625975725959118NN
primary0.0108390366114755JJ
care0.104031537001265NN
focus0NN
preventable0.0307735781890304JJ
disease0.215415047323213NN
limited0JJ
reach0NN
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public0.021678073222951NN
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rural0JJ

Label: 2, with a score of: 0.171059450031036
WordScorePoS
regional0.0252000451111224JJ
health0NN
support0.00896409157262106NN
primary0.0155217067874935JJ
care0NN
focus0NN
preventable0JJ
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limited0JJ
reach0NN
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public0NN
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rural0.148975141598503JJ

Label: 5, with a score of: 0.331810463672684
WordScorePoS
regional0JJ
health0.0571058915334038NN
support0NN
primary0.0970239057629001JJ
care0.0931221694711702NN
focus0NN
preventable0JJ
disease0NN
limited0JJ
reach0NN
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public0.0727679293221751NN
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rural0JJ

This change was facilitated by strong regionwide commitment to empower households resulting in wave of household latrine building

Label: 13, with a score of: 0.667560233709293
WordScorePoS
change0.402565546215053NN
facilitate0VB
strong0JJ
commitment0.0414107553022249NN
empower0VB
household0NN
result0NN
latrine0NN
building0NN

Label: 17, with a score of: 0.368379934205878
WordScorePoS
change0NN
facilitate0.0211360962287062VB
strong0JJ
commitment0.0739231123597559NN
empower0VB
household0NN
result0NN
latrine0NN
building0.149940347231585NN

At the village level after consultation meetings highlighted the need to build latrines community health promoters visited each household to persuade it to join the community in building latrines

Label: 17, with a score of: 0.422902232491067
WordScorePoS
level0.0138997399903163NN
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latrine0NN
community0NN
health0NN
household0NN
building0.149940347231585NN

Label: 3, with a score of: 0.378534389524634
WordScorePoS
level0NN
build0VB
latrine0NN
community0NN
health0.191387734041787NN
household0NN
building0NN

Label: 16, with a score of: 0.337929412035612
WordScorePoS
level0.0610668815653026NN
build0VB
latrine0NN
community0NN
health0NN
household0NN
building0.109790895760528NN

Within less than two years pit latrine ownership rose from percent to percent WSP although it may not necessarily have resulted in corresponding increase in use

Label: 6, with a score of: 0.678334542048016
WordScorePoS
latrine0.0683326727248364NN
ownership0NN
rise0.0251182378961834NN
result0.0683326727248364NN
increase0.00905621749519576NN

Label: 13, with a score of: 0.537799489056759
WordScorePoS
latrine0NN
ownership0NN
rise0.120914181920259NN
result0NN
increase0.0145316075945746NN

The longterm success will depend on many factors including durability technical standards design and behavior with regard to toilet use and especially children compliance with latrine use

Label: 4, with a score of: 0.563146783714044
WordScorePoS
depend0VB
include0VB
technical0.124876512346911JJ
standard0NN
regard0NN
toilet0NN
child0.076326555629389NN
latrine0NN

Label: 6, with a score of: 0.454152459820859
WordScorePoS
depend0VB
include0VB
technical0JJ
standard0NN
regard0NN
toilet0.0683326727248364NN
child0.0255958462813622NN
latrine0.0683326727248364NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL and ventilation practices that may help improve indoor air

Label: 3, with a score of: 0.618916065119159
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
practice0NN
improve0VB
air0.020806307400253NN

Label: 12, with a score of: 0.4258864182544
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
practice0.0703006268489394NN
improve0VB
air0.0554128417527413NN

Label: 11, with a score of: 0.327519866218403
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
child0.0273960270556257NN
practice0NN
improve0.0273960270556257VB
air0.0373517915079663NN

The analysis also suggests that poor families may not have to wait for clean fuels or clean stoves to enjoy significantly cleaner air when basic modifications in cooking behaviors may produce cleaner conditions even when dirty biomass fuels are used Dasgupta and others

Label: 7, with a score of: 0.801929106851613
WordScorePoS
suggest0VB
poor0JJ
family0NN
clean0.125032076213024JJ
fuel0.0749457204978913NN
significantly0RB
cleaner0.0924643738905717JJR
air0NN
basic0JJ
cooking0.122412709674631NN
produce0VB
condition0NN

Label: 1, with a score of: 0.243372046306497
WordScorePoS
suggest0VB
poor0.150659516460257JJ
family0NN
clean0JJ
fuel0NN
significantly0RB
cleaner0JJR
air0NN
basic0.0639932865717261JJ
cooking0NN
produce0VB
condition0NN

Vector Control Programs Malaria continues to be major public health challenge especially in Sub Saharan Africa where it is responsible for at least deaths among children under five years of age Snow and others

Label: 3, with a score of: 0.806243747991303
WordScorePoS
control0.020806307400253NN
malaria0.20370424488904NN
continue0VB
major0.0108390366114755JJ
public0.021678073222951NN
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challenge0NN
saharan0.0299516555085695JJ
africa0IN
responsible0JJ
death0.193573191943949NN
child0.10682408961305NN
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Although key strategies in the control of malaria have often focused on early diagnosis and treatment indoor residual spraying and the use of insecticide treated nets environmental management interventions can play major role within integrated vector management by adding resilience to the results of individual control strategies and by reducing costs as well as the likelihood of development and spread of drug and insecticide resistance Keiser Singer and Utzinger

Label: 3, with a score of: 0.556660207461839
WordScorePoS
key0NN
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environmental0JJ
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review of studies on malaria interventions that emphasized environmental management interventions reported very high protective efficacies

Label: 3, with a score of: 0.80701989190519
WordScorePoS
review0NN
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malaria0.20370424488904NN
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Label: 12, with a score of: 0.330909405306597
WordScorePoS
review0NN
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intervention0NN
environmental0.0598270388037045JJ
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Label: 11, with a score of: 0.300709081776067
WordScorePoS
review0NN
study0NN
malaria0NN
intervention0NN
environmental0.0537696560159885JJ
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Often package of multiple interventions is used guided by multisectoral staff with expertise in malaria epidemiology and entomology vector ecology and land and water engineering Keiser Singer and Utzinger

Label: 6, with a score of: 0.801776550379635
WordScorePoS
multiple0JJ
intervention0NN
expertise0NN
malaria0NN
land0NN
water0.556409482163189NN
engineering0NN

Label: 3, with a score of: 0.407398491257746
WordScorePoS
multiple0JJ
intervention0.0407408489778079NN
expertise0NN
malaria0.20370424488904NN
land0NN
water0.0382775468083574NN
engineering0NN

Label: 12, with a score of: 0.290113160773447
WordScorePoS
multiple0JJ
intervention0NN
expertise0NN
malaria0NN
land0.0144336476662975NN
water0.186896403054502NN
engineering0NN

In Malaysia for example the incidence of malaria was radically reduced by environmental management methods devised by interdisciplinary teams of medically qualified personnel across many different departments such as agriculture health transportation urban planning and the army Flemming and others

Label: 11, with a score of: 0.64471526194641
WordScorePoS
incidence0NN
malaria0NN
reduce0.0200483235258943VB
environmental0.0537696560159885JJ
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devise0VB
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agriculture0NN
health0.0229054731708393NN
transportation0.04477822029736NN
urban0.27622591898666JJ
plan0.0583751976558017NN

Label: 3, with a score of: 0.576320038598161
WordScorePoS
incidence0.0407408489778079NN
malaria0.20370424488904NN
reduce0.01675146888405VB
environmental0JJ
management0.0127591822694525NN
devise0VB
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agriculture0NN
health0.191387734041787NN
transportation0NN
urban0JJ
plan0.021678073222951NN

Label: 2, with a score of: 0.185752961239066
WordScorePoS
incidence0NN
malaria0NN
reduce0.00799614078871077VB
environmental0JJ
management0NN
devise0VB
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agriculture0.148975141598503NN
health0NN
transportation0NN
urban0JJ
plan0NN

Although environmental vector control measures may work in Asia they are much less likely to succeed in rural Africa

Label: 2, with a score of: 0.583646512670618
WordScorePoS
environmental0JJ
control0NN
measure0.0504000902222448NN
asia0IN
rural0.148975141598503JJ
africa0IN

Label: 1, with a score of: 0.61335464939527
WordScorePoS
environmental0.0442083771593746JJ
control0.0614198493690006NN
measure0.103895385378356NN
asia0IN
rural0JJ
africa0IN

The African vectors are far more efficient so their numbers must be reduced to much lower levels to reduce transmission significantly

Label: 12, with a score of: 0.698469742739603
WordScorePoS
african0IN
efficient0.108503934593034JJ
reduce0.022306853314744VB
level0.00513687014008325NN
significantly0RB

Label: 16, with a score of: 0.464591732567366
WordScorePoS
african0IN
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reduce0.0220985725470694VB
level0.0610668815653026NN
significantly0RB

For this reason mosquito ecology demands that environmental manipulation be supplemented by bednets and indoor residual spraying Touré

Label: 0, with a score of: 1

Lessons learned from successful vector control programs show the need for interdisciplinary collaborations among the health agricultural water and infrastructure development sectors in the design of integrated intervention packages

Label: 6, with a score of: 0.612335252010342
WordScorePoS
learn0VB
successful0JJ
control0NN
health0NN
agricultural0JJ
water0.556409482163189NN
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Label: 9, with a score of: 0.388481127096262
WordScorePoS
learn0VB
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health0.0377086395700813NN
agricultural0.0368585655748969JJ
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development0.0330049940546426NN
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Label: 12, with a score of: 0.30462049465885
WordScorePoS
learn0VB
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health0.0339811641917276NN
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water0.186896403054502NN
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Label: 2, with a score of: 0.295583641258143
WordScorePoS
learn0VB
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agricultural0.250032943963815JJ
water0NN
infrastructure0.0155217067874935NN
development0.0159922815774215NN
sector0.0182713919265625NN
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Label: 3, with a score of: 0.295356739385795
WordScorePoS
learn0VB
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control0.020806307400253NN
health0.191387734041787NN
agricultural0JJ
water0.0382775468083574NN
infrastructure0NN
development0.00837573444202498NN
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Label: 4, with a score of: 0.268600464080806
WordScorePoS
learn0.244520809605025VB
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agricultural0JJ
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development0.0279277626235394NN
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Collaboration in this context means that the higher expenses of environmental management are not borne by the health sector and that vector control per se is not the driving force Keiser Singer and Utzinger

Label: 3, with a score of: 0.58733498605885
WordScorePoS
context0NN
means0NNS
environmental0JJ
management0.0127591822694525NN
bear0.0814816979556159NN
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sector0NN
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force0.020806307400253NN

Label: 1, with a score of: 0.405437103312935
WordScorePoS
context0NN
means0.120266261535276NNS
environmental0.0442083771593746JJ
management0NN
bear0NN
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drive0NN
force0NN

Label: 5, with a score of: 0.372124516432349
WordScorePoS
context0NN
means0NNS
environmental0JJ
management0NN
bear0NN
health0.0571058915334038NN
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control0.0465610847355851NN
drive0NN
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Effective vector control programs should encourage community participation Keiser Singer and Utzinger

Label: 1, with a score of: 0.470855111784658
WordScorePoS
effective0JJ
control0.0614198493690006NN
encourage0VB
community0NN
participation0.0614198493690006NN

Label: 5, with a score of: 0.435392365906013
WordScorePoS
effective0.02046578088155JJ
control0.0465610847355851NN
encourage0VB
community0NN
participation0.0465610847355851NN

Label: 16, with a score of: 0.395396976053951
WordScorePoS
effective0.0482582488828229JJ
control0NN
encourage0VB
community0NN
participation0.0548954478802642NN

In the case of dengue control novel effort carried out in several communes in Vietnam demonstrates how communitybased approach can be highly effective against this mosquito see box

Label: 0, with a score of: 1

APPROACHES TO ENVIRONMENTAL HEALTH BOX

Label: 3, with a score of: 0.683030126222187
WordScorePoS
approach0NN
environmental0JJ
health0.191387734041787NN

Label: 12, with a score of: 0.528401453255662
WordScorePoS
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN

Vietnam Dengue Program The dengue control case in Vietnam shows that community based approach can be highly effective against this disease

Label: 3, with a score of: 0.734230269779476
WordScorePoS
control0.020806307400253NN
community0NN
base0.0149758277542848NN
approach0NN
highly0RB
effective0.00914534810831654JJ
disease0.215415047323213NN

Label: 6, with a score of: 0.351488692781288
WordScorePoS
control0NN
community0.0214003646985842NN
base0NN
approach0NN
highly0RB
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disease0.103230094596636NN

The approach involves smooth interface among technical experts health workers and communities

Label: 3, with a score of: 0.489640486541887
WordScorePoS
approach0NN
involve0VB
technical0JJ
health0.191387734041787NN
worker0NN
community0NN

Label: 12, with a score of: 0.47888092638276
WordScorePoS
approach0.0542519672965169NN
involve0.0819583881728876VB
technical0JJ
health0.0339811641917276NN
worker0NN
community0.0169905820958638NN

Label: 8, with a score of: 0.416182672168962
WordScorePoS
approach0NN
involve0VB
technical0.0410992516792148JJ
health0NN
worker0.121575732851624NN
community0NN

Label: 9, with a score of: 0.33970759157902
WordScorePoS
approach0NN
involve0VB
technical0.030745604615229JJ
health0.0377086395700813NN
worker0.0454743001434393NN
community0.0188543197850406NN

Label: 4, with a score of: 0.319480224630516
WordScorePoS
approach0NN
involve0VB
technical0.124876512346911JJ
health0NN
worker0NN
community0NN

Dengue control was driven by the chair of each commune and by other leaders from the women union and youth union it was implemented by communal health personnel health collaborators schoolteachers and their pupils

Label: 3, with a score of: 0.631786733597514
WordScorePoS
control0.020806307400253NN
drive0NN
woman0.0381514605760894NN
youth0NN
implement0VB
health0.191387734041787NN

Label: 5, with a score of: 0.547429444605653
WordScorePoS
control0.0465610847355851NN
drive0NN
woman0.221979360474357NN
youth0NN
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health0.0571058915334038NN

Health collaborators were each responsible for monthly inspection of water storage containers in about houses delivery of health education messages to make sure that the householder knew how to manage the mesocyclops tiny one eyed shrimplike creature used for biological control of larvae to combat mosquitoes successfully that inhabited those containers and reporting of any suspected dengue cases to the communal health center

Label: 3, with a score of: 0.625115590504743
WordScorePoS
health0.191387734041787NN
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Label: 6, with a score of: 0.496823938452123
WordScorePoS
health0NN
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Label: 12, with a score of: 0.303571628185203
WordScorePoS
health0.0339811641917276NN
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Label: 4, with a score of: 0.218088935961915
WordScorePoS
health0NN
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The program was not simply matter of the health volunteers eliminating the mosquitoes for the householders the success of the mosquito control efforts depended on the close involvement of the householders

Label: 3, with a score of: 0.602919238577914
WordScorePoS
health0.191387734041787NN
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Label: 5, with a score of: 0.488942842708565
WordScorePoS
health0.0571058915334038NN
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Schoolchildren participated by cleaning up discarded containers supporting the aged and infirm in mosquito control measures and disseminating information about mosquito control through plays songs quiz nights and in one district Meso football cup

Label: 0, with a score of: 1

This control strategy has already been implemented in communes in Vietnam

Label: 1, with a score of: 0.765229030233917
WordScorePoS
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Label: 17, with a score of: 0.324066245634144
WordScorePoS
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Label: 8, with a score of: 0.303328386448644
WordScorePoS
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Mosquitoes have been eliminated in of those communes and the remaining communes show very low densities of mosquitoes

Label: 10, with a score of: 0.536026309877283
WordScorePoS
eliminate0.0558912165956601VB
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Label: 4, with a score of: 0.477686753837888
WordScorePoS
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Label: 5, with a score of: 0.442063915033151
WordScorePoS
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Label: 11, with a score of: 0.410507376682103
WordScorePoS
eliminate0VB
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Sources Das Gupta and others Ha and Huan Kay and Nam Vu and others

Label: 0, with a score of: 1

Understanding the Enabling Environment As the preceding section shows developing countries have used range of ways to mainstream environmental health actions into existing child survival and nutrition programs infrastructure projects and vector control strategies

Label: 3, with a score of: 0.436227903330448
WordScorePoS
enable0VB
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Label: 9, with a score of: 0.394428887438073
WordScorePoS
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Label: 2, with a score of: 0.324039278270474
WordScorePoS
enable0VB
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Label: 12, with a score of: 0.381940766258674
WordScorePoS
enable0VB
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Given the varying socioeconomic institutional and developmental contexts of developing countries knowing what combination of factors contributed to the successful inclusion of environmental health considerations within these programs is often difficult

Label: 3, with a score of: 0.499866124444385
WordScorePoS
institutional0JJ
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Looking at the big picture however can help identify some common elements that provided the appropriate enabling environment

Label: 11, with a score of: 0.612487766019698
WordScorePoS
identify0VB
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Label: 12, with a score of: 0.408913919144351
WordScorePoS
identify0VB
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Label: 3, with a score of: 0.315503108168017
WordScorePoS
identify0VB
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Some of these common elements have included obtaining high level political commitment involving and empowering communities allocating responsibilities and resources at the local level and finding balance between private and public sector roles

Label: 5, with a score of: 0.625221557853265
WordScorePoS
common0JJ
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Label: 17, with a score of: 0.403651435326441
WordScorePoS
common0JJ
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Political Will and Effective Consensus The existence of positive policy environment is central principle for successful interventions

Label: 3, with a score of: 0.441951851353421
WordScorePoS
environmental0JJ
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Label: 10, with a score of: 0.545355670656606
WordScorePoS
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Label: 5, with a score of: 0.305260534020592
WordScorePoS
environmental0JJ
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High level political commitment is critical to successful child survival and environmental health programs

Label: 3, with a score of: 0.558941118065049
WordScorePoS
level0NN
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Label: 5, with a score of: 0.380641230417878
WordScorePoS
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Label: 17, with a score of: 0.325600212012264
WordScorePoS
level0.0138997399903163NN
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Label: 10, with a score of: 0.314437718872416
WordScorePoS
level0NN
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The Ethiopian example shows the need for well connected leadership that is well informed and willing to take risks and challenge conventional primary health care approaches

Label: 3, with a score of: 0.657116611740786
WordScorePoS
leadership0NN
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Label: 5, with a score of: 0.551512780185499
WordScorePoS
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Label: 11, with a score of: 0.315540181287532
WordScorePoS
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The right context is required to implement interventions

Label: 8, with a score of: 0.606437963112951
WordScorePoS
context0NN
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Label: 17, with a score of: 0.468813685180103
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Label: 13, with a score of: 0.446792120457026
WordScorePoS
context0.0414107553022249NN
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Label: 12, with a score of: 0.303105766147302
WordScorePoS
context0NN
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In the case of Ethiopia the intervention was driven by population expansion and deforestation which reduced the private open defecation option

Label: 15, with a score of: 0.427337981346763
WordScorePoS
intervention0NN
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Label: 10, with a score of: 0.402511598830245
WordScorePoS
intervention0NN
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Label: 6, with a score of: 0.392055421531689
WordScorePoS
intervention0NN
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Label: 11, with a score of: 0.3872003645369
WordScorePoS
intervention0NN
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The success of the story came from the willingness of senior management to listen to the people and put their needs first WSP

Label: 11, with a score of: 0.535281577698249
WordScorePoS
management0.0687164195125178NN
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An important first step in the program was facilitating consensus around the need for community ownership of health behavior especially with respect to vaccination family planning and hygiene and sanitation

Label: 6, with a score of: 0.735455009129454
WordScorePoS
facilitate0VB
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Label: 3, with a score of: 0.453512101300401
WordScorePoS
facilitate0VB
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Consultation and advocacy meetings at all levels and covering the whole region were conducted to bring sustained massive response Knapp

Label: 1, with a score of: 0.610785708256704
WordScorePoS
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Label: 3, with a score of: 0.389728273972122
WordScorePoS
level0NN
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Label: 9, with a score of: 0.375892578144803
WordScorePoS
level0NN
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As Shiferaw Teklemariam state health minister in Ethiopia points out [N]one of these achievements would have been possible without close inter sectoral collaboration and strong leadership committed to universal water supply and sanitation access WSP

Label: 6, with a score of: 0.856258548178792
WordScorePoS
health0NN
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Label: 12, with a score of: 0.258344649463974
WordScorePoS
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Label: 3, with a score of: 0.245582767546749
WordScorePoS
health0.191387734041787NN
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China improved cookstoves programs have been found to be broadly successful in delivering better stoves to majority of households in targeted counties and the success was based on strong administrative technical and outreach competence and resources situated at the local level motivated by sustained national level attention Sinton and others

Label: 0, with a score of: 1

In Brazil similarly favoring democratic and continuous process in education on health and disease processes has been found necessary in stimulating the participation of the population in health promotion programs Mahendradhata and Moerman

Label: 3, with a score of: 0.658170674594348
WordScorePoS
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Label: 4, with a score of: 0.306709969517002
WordScorePoS
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Label: 5, with a score of: 0.473163303989538
WordScorePoS
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Involving and Empowering Communities Participatory governance mechanisms that encourage the involvement of poorer groups are an important factor for improving environmental health Satterthwaite

Label: 3, with a score of: 0.349411393166042
WordScorePoS
involve0VB
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Label: 17, with a score of: 0.341969553927924
WordScorePoS
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Label: 12, with a score of: 0.437475505857279
WordScorePoS
involve0.0819583881728876VB
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Label: 10, with a score of: 0.389071789612126
WordScorePoS
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Label: 16, with a score of: 0.344475189414728
WordScorePoS
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Several programs that have been successful in achieving child health outcomes through environmental health actions have included community participation as an integral component

Label: 3, with a score of: 0.654390641392077
WordScorePoS
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Label: 5, with a score of: 0.386221667340487
WordScorePoS
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In Ethiopia community health promoters visited households promoting simple and action based health messages to undertake actions at individual household and community levels that would lead to behavioral change in practices Knapp

Label: 13, with a score of: 0.577033425384882
WordScorePoS
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Label: 3, with a score of: 0.394242504014554
WordScorePoS
community0NN
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Label: 5, with a score of: 0.384480037383611
WordScorePoS
community0NN
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Label: 12, with a score of: 0.332794256844138
WordScorePoS
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Lessons learned from many programs highlight the need to cultivate sense of local ownership

Label: 4, with a score of: 0.851068135182458
WordScorePoS
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Community groups are potentially quite influential for behavior change and for maintaining infrastructure as the Bangladesh sanitation story demonstrates WSP

Label: 13, with a score of: 0.618384996636493
WordScorePoS
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Label: 6, with a score of: 0.529729266543098
WordScorePoS
community0.0214003646985842NN
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Label: 9, with a score of: 0.403063282481044
WordScorePoS
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In Thailand effective consensus and commitment building in the multisectoral nutrition program was instrumental in reducing APPROACHES TO ENVIRONMENTAL HEALTH malnutrition among children Heaver and Kachondam

Label: 3, with a score of: 0.462121096759661
WordScorePoS
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Label: 2, with a score of: 0.389782215545079
WordScorePoS
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Label: 17, with a score of: 0.355293889230315
WordScorePoS
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Label: 16, with a score of: 0.342971545496421
WordScorePoS
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In Vietnam the success of the dengue control program also lay in the extensive community involvement Das Gupta and others

Label: 0, with a score of: 1

Another example is the large program of toilet blocks in urban slums in India that were designed built and managed by the communities

Label: 11, with a score of: 0.891526831335203
WordScorePoS
toilet0NN
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The National Slum Dwellers Federation develops and promotes these blocks through women saving group Mahila Milan that is supported by local authorities thus improving sanitation for millions of slum dwellers Burra Patel and Kerr

Label: 6, with a score of: 0.618670337602362
WordScorePoS
national0JJ
slum0NN
develop0VB
promote0VB
woman0.0127979231406811NN
save0IN
support0.0209983814716066NN
local0.0181797964452808JJ
improve0.0511916925627245VB
sanitation0.334686906581616NN
million0CD

Label: 11, with a score of: 0.557118148273904
WordScorePoS
national0.00501208088147356JJ
slum0.146277152173395NN
develop0VB
promote0VB
woman0.0273960270556257NN
save0IN
support0.0224752180723703NN
local0.0194583992186006JJ
improve0.0273960270556257VB
sanitation0NN
million0CD

Label: 5, with a score of: 0.340131328887686
WordScorePoS
national0.0124956749436837JJ
slum0NN
develop0VB
promote0.00624783747184187VB
woman0.221979360474357NN
save0IN
support0NN
local0JJ
improve0VB
sanitation0NN
million0CD

A key feature in Mumbai was the involvement of the slum community in project implementation at the planning stage

Label: 11, with a score of: 0.595688032681393
WordScorePoS
key0NN
feature0NN
slum0.146277152173395NN
community0NN
project0NN
implementation0NN
plan0.0583751976558017NN
stage0NN

Label: 12, with a score of: 0.342874895077997
WordScorePoS
key0NN
feature0NN
slum0NN
community0.0169905820958638NN
project0.0664302389559493NN
implementation0.0199423462679015NN
plan0.0144336476662975NN
stage0NN

Label: 13, with a score of: 0.341218092395977
WordScorePoS
key0NN
feature0NN
slum0NN
community0.0343390275626203NN
project0.0335649154577099NN
implementation0.0201523636533764NN
plan0.0291713033871158NN
stage0NN

Their involvement facilitated collaboration between the NGO contractors and community based organizations WSP

Label: 0, with a score of: 1

Balancing Private and Public Sector Roles The nature and complexity of environmental health issues require intersectoral actions not only across various levels of government but also through partnerships between the public and private sectors

Label: 17, with a score of: 0.714663623747635
WordScorePoS
private0.0898760357768464JJ
public0.0390556786919513NN
sector0.0459744293658165NN
nature0NN
environmental0JJ
health0NN
issue0.0299586785922821NN
require0.0211360962287062VB
action0.0109843026967392NN
level0.0138997399903163NN
government0.048933054487825NN
partnership0.3914644359026NN

Label: 12, with a score of: 0.340308854935701
WordScorePoS
private0JJ
public0.028867295332595NN
sector0.0169905820958638NN
nature0.162755901889551NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
issue0NN
require0.0468670845659596VB
action0.0121782716594324NN
level0.00513687014008325NN
government0NN
partnership0NN

Label: 3, with a score of: 0.214259156058916
WordScorePoS
private0JJ
public0.021678073222951NN
sector0NN
nature0NN
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
require0VB
action0NN
level0NN
government0NN
partnership0NN

Label: 5, with a score of: 0.401549680912768
WordScorePoS
private0.0558185411034276JJ
public0.0727679293221751NN
sector0.0571058915334038NN
nature0NN
environmental0JJ
health0.0571058915334038NN
issue0NN
require0VB
action0.0409315617631NN
level0.0172651853471334NN
government0NN
partnership0NN

While the public sector retains its power over setting regulations and standards the private sector is increasingly getting involved in the delivery of environmental services such as water sanitation and energy

Label: 6, with a score of: 0.659435657482512
WordScorePoS
public0NN
sector0.0214003646985842NN
power0NN
set0NN
regulation0NN
standard0NN
private0JJ
involve0VB
environmental0JJ
service0.0084006124696649NN
water0.556409482163189NN
sanitation0.334686906581616NN
energy0.0153390539205676NN

Label: 12, with a score of: 0.394668405055111
WordScorePoS
public0.028867295332595NN
sector0.0169905820958638NN
power0NN
set0NN
regulation0NN
standard0.0409791940864438NN
private0JJ
involve0.0819583881728876VB
environmental0.0598270388037045JJ
service0.00666957305782837NN
water0.186896403054502NN
sanitation0NN
energy0.133960988253756NN

Label: 7, with a score of: 0.371685631520747
WordScorePoS
public0NN
sector0NN
power0NN
set0NN
regulation0NN
standard0NN
private0JJ
involve0VB
environmental0JJ
service0.0451471467893167NN
water0NN
sanitation0NN
energy0.494617163780726NN

Label: 9, with a score of: 0.316321754456063
WordScorePoS
public0.0160169090870187NN
sector0.0565629593551219NN
power0.0454743001434393NN
set0NN
regulation0NN
standard0.0454743001434393NN
private0.0368585655748969JJ
involve0VB
environmental0.0221298700466866JJ
service0.0148023490369527NN
water0.0377086395700813NN
sanitation0.0737171311497939NN
energy0.0540565419125769NN

However the question of who provides and pays for an intervention is important

Label: 5, with a score of: 0.635778101971665
WordScorePoS
pay0.078760887431929NN
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Label: 8, with a score of: 0.561198356384009
WordScorePoS
pay0.0695218668857431NN
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Label: 3, with a score of: 0.328870591487577
WordScorePoS
pay0NN
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Improved stoves are an example of private gains to public health measures

Label: 3, with a score of: 0.48605385577656
WordScorePoS
improve0VB
private0JJ
gain0NN
public0.021678073222951NN
health0.191387734041787NN
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Label: 5, with a score of: 0.423608507048184
WordScorePoS
improve0VB
private0.0558185411034276JJ
gain0NN
public0.0727679293221751NN
health0.0571058915334038NN
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Label: 11, with a score of: 0.350067219262488
WordScorePoS
improve0.0273960270556257VB
private0JJ
gain0.04477822029736NN
public0.0583751976558017NN
health0.0229054731708393NN
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Label: 17, with a score of: 0.335937211983337
WordScorePoS
improve0.0183291958415182VB
private0.0898760357768464JJ
gain0NN
public0.0390556786919513NN
health0NN
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To be sure the absence of credit is possible constraint for individuals to obtain these stoves but if the stoves save more on fuel than they cost one would expect widespread adoption

Label: 9, with a score of: 0.630559491805523
WordScorePoS
credit0.0602029956716497NN
constraint0.0602029956716497NN
individual0JJ
obtain0VB
save0IN
fuel0NN
cost0NN
expect0VB
adoption0.0602029956716497NN

Label: 10, with a score of: 0.456593392204021
WordScorePoS
credit0NN
constraint0NN
individual0.064698038783335JJ
obtain0VB
save0IN
fuel0NN
cost0.0660824365173543NN
expect0VB
adoption0NN

In contrast if the benefits are more general than individual the scope for subsidies is clearer

Label: 14, with a score of: 0.822326084330894
WordScorePoS
benefit0.0229784274580034NN
individual0JJ
subsidy0.162850158165781NN

An evaluation of costs and benefits is necessary to determine the role of the private and public sectors

Label: 5, with a score of: 0.612961252066702
WordScorePoS
cost0NN
benefit0.0393804437159645NN
determine0VB
private0.0558185411034276JJ
public0.0727679293221751NN
sector0.0571058915334038NN

Label: 17, with a score of: 0.476337816989972
WordScorePoS
cost0NN
benefit0NN
determine0VB
private0.0898760357768464JJ
public0.0390556786919513NN
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Label: 9, with a score of: 0.368862769674708
WordScorePoS
cost0NN
benefit0.0260040237236563NN
determine0VB
private0.0368585655748969JJ
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sector0.0565629593551219NN

In the water sector the privatization of water companies not only can lead to efficiency gains but also can have beneficial health effects

Label: 6, with a score of: 0.823852154310074
WordScorePoS
water0.556409482163189NN
sector0.0214003646985842NN
company0NN
lead0NN
efficiency0.0502364757923669NN
gain0.041835863322702NN
health0NN
effect0NN

Label: 12, with a score of: 0.441102161005451
WordScorePoS
water0.186896403054502NN
sector0.0169905820958638NN
company0.108503934593034NN
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efficiency0.039884692535803NN
gain0.0664302389559493NN
health0.0339811641917276NN
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Label: 3, with a score of: 0.197154267357078
WordScorePoS
water0.0382775468083574NN
sector0NN
company0NN
lead0.025518364538905NN
efficiency0NN
gain0NN
health0.191387734041787NN
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Label: 7, with a score of: 0.116446751311697
WordScorePoS
water0NN
sector0NN
company0NN
lead0.0383371018038178NN
efficiency0.134992154141495NN
gain0NN
health0NN
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In Argentina for example the privatization of public water companies resulted in both increases in connections and improvements in quality financed from user fees and connection charges

Label: 6, with a score of: 0.813918860202937
WordScorePoS
public0NN
water0.556409482163189NN
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result0.0683326727248364NN
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quality0.0255958462813622NN
finance0NN
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Label: 12, with a score of: 0.437174722720366
WordScorePoS
public0.028867295332595NN
water0.186896403054502NN
company0.108503934593034NN
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increase0.00958677785775002NN
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quality0.0203215381458133NN
finance0NN
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These improvements included the speed of repairs of water leaks and sewer blockages and the percentage of clients with appropriate water pressure

Label: 6, with a score of: 0.925851880285941
WordScorePoS
improvement0NN
include0VB
water0.556409482163189NN
percentage0NN
pressure0NN

Label: 12, with a score of: 0.31099108073061
WordScorePoS
improvement0NN
include0VB
water0.186896403054502NN
percentage0NN
pressure0NN

Child mortality fell by percent in the areas that privatized their water services and that effect was largest percent in the poorest areas especially in poorer municipalities Galiani Gertler and Schargrodsky Wagstaff and Claeson

Label: 6, with a score of: 0.668124333899111
WordScorePoS
child0.0255958462813622NN
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water0.556409482163189NN
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effect0NN
largest0JJS
poorest0.0348974218717993JJS

Label: 3, with a score of: 0.593193843835932
WordScorePoS
child0.10682408961305NN
mortality0.276962203701274NN
fall0.123094312756122NN
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service0.0100171139310145NN
effect0NN
largest0JJS
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Label: 12, with a score of: 0.206821435086122
WordScorePoS
child0NN
mortality0NN
fall0NN
water0.186896403054502NN
service0.00666957305782837NN
effect0NN
largest0JJS
poorest0JJS

In the field of sanitation concepts of sanitation marketing are proving to be extremely effective

Label: 6, with a score of: 0.964064000146439
WordScorePoS
field0NN
sanitation0.334686906581616NN
effective0JJ

In bid to harness market power for rural sanitation IDE an international NGO developed range of low cost sanitation options and stimulated network of local masons to market and deliver them to the rural population in two Vietnamese provinces

Label: 6, with a score of: 0.686124173318461
WordScorePoS
market0NN
power0NN
rural0JJ
sanitation0.334686906581616NN
international0.00301873916506525JJ
develop0VB
range0NN
cost0NN
stimulate0VB
local0.0181797964452808JJ
deliver0VB
population0.0363595928905615NN

Label: 2, with a score of: 0.502497617984535
WordScorePoS
market0.0913569596328122NN
power0NN
rural0.148975141598503JJ
sanitation0NN
international0.00515473144367677JJ
develop0VB
range0NN
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stimulate0VB
local0.0155217067874935JJ
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population0.0310434135749871NN

As result the sanitation access rate increased markedly in the area even among the poor Frias and Mukherjee

Label: 6, with a score of: 0.84827484046973
WordScorePoS
result0.0683326727248364NN
sanitation0.334686906581616NN
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Label: 1, with a score of: 0.385556784387432
WordScorePoS
result0NN
sanitation0NN
access0.00514687440545096NN
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poor0.150659516460257JJ

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL In hygiene behavior the private sector has begun to play an important role in advocating for and supporting hand washing campaigns through the Global Public Private Partnership for Handwashing with Soap

Label: 17, with a score of: 0.729441337638913
WordScorePoS
environmental0JJ
health0NN
child0NN
hygiene0NN
private0.0898760357768464JJ
sector0.0459744293658165NN
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global0.0201198688839505JJ
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partnership0.3914644359026NN

Label: 3, with a score of: 0.343863496414159
WordScorePoS
environmental0JJ
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child0.10682408961305NN
hygiene0NN
private0JJ
sector0NN
support0.00625975725959118NN
global0.013959557403375JJ
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Label: 6, with a score of: 0.216387929297758
WordScorePoS
environmental0JJ
health0NN
child0.0255958462813622NN
hygiene0.136665345449673NN
private0JJ
sector0.0214003646985842NN
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global0.00936547854413134JJ
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Label: 5, with a score of: 0.319176887701118
WordScorePoS
environmental0JJ
health0.0571058915334038NN
child0.0170753354211044NN
hygiene0NN
private0.0558185411034276JJ
sector0.0571058915334038NN
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global0JJ
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In campaigns such as those in Ghana Peru and Senegal the private sector has engaged in hand washing promotion and educational activities mainly by contributing its marketing expertise to publicly funded generic campaigns not tied to any specific soap brands

Label: 17, with a score of: 0.499949607126855
WordScorePoS
private0.0898760357768464JJ
sector0.0459744293658165NN
engage0VB
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educational0JJ
activity0NN
contribute0.0249900578719309VB
expertise0.048933054487825NN
fund0NN
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In providing rural energy technologies too the private sector is beginning to play an important role in collaboration with the public sector

Label: 7, with a score of: 0.665711376452159
WordScorePoS
provide0VB
rural0JJ
energy0.494617163780726NN
technology0.109914925284606NN
private0JJ
sector0NN
public0NN

Label: 2, with a score of: 0.256830477217123
WordScorePoS
provide0.0215170467912497VB
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energy0.0130963126055467NN
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private0JJ
sector0.0182713919265625NN
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Label: 12, with a score of: 0.238760394976421
WordScorePoS
provide0.0200087191734851VB
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sector0.0169905820958638NN
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Label: 17, with a score of: 0.382913579736099
WordScorePoS
provide0.00601568197638796VB
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energy0.0109843026967392NN
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private0.0898760357768464JJ
sector0.0459744293658165NN
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Label: 9, with a score of: 0.339768894279126
WordScorePoS
provide0.00740117451847634VB
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Label: 5, with a score of: 0.32478619174306
WordScorePoS
provide0.0112083245137075VB
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technology0.0409315617631NN
private0.0558185411034276JJ
sector0.0571058915334038NN
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In Nepal for example the Alternative Energy Promotion Center quasi governmental body is working closely with private sector contractors who deliver improved cookstove technologies to rural households World Bank

Label: 7, with a score of: 0.647529429394313
WordScorePoS
alternative0NN
energy0.494617163780726NN
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private0JJ
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world0.00261936653839306NN
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Label: 2, with a score of: 0.355283383114603
WordScorePoS
alternative0NN
energy0.0130963126055467NN
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bank0.0881366997038154NN

Label: 12, with a score of: 0.250987357306984
WordScorePoS
alternative0NN
energy0.133960988253756NN
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Label: 17, with a score of: 0.381384163733526
WordScorePoS
alternative0NN
energy0.0109843026967392NN
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world0.00418824502414673NN
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Label: 5, with a score of: 0.307684210526033
WordScorePoS
alternative0NN
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This section has provided examples of interventions in different sectors that have provided some key lessons however contexts actors and situations are different which makes comparison difficult

Label: 0, with a score of: 1

Governance and Institutional Implications final key issue is that environmental health efforts will not be sustainable unless explicit attention is paid to institutional issues

Label: 3, with a score of: 0.432878203444785
WordScorePoS
governance0NN
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Label: 11, with a score of: 0.388128393598306
WordScorePoS
governance0NN
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Label: 12, with a score of: 0.371164947608496
WordScorePoS
governance0NN
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Therefore the ultimate design and delivery of environmental health interventions must depend on the institutional and governance structure of each country an issue that is elaborated on in this section

Label: 3, with a score of: 0.674932207533697
WordScorePoS
environmental0JJ
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Unraveling the Environmental Health Agenda in the Developed World Earlier this report discussed how across the developed world countries sought to establish strong and coherent systems for ensuring environmental sanitation to protect the public health

Label: 3, with a score of: 0.512938972404432
WordScorePoS
environmental0JJ
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Label: 6, with a score of: 0.393892745661242
WordScorePoS
environmental0JJ
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Label: 1, with a score of: 0.310803671646133
WordScorePoS
environmental0.0442083771593746JJ
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As result of those efforts mechanisms to ensure environmental sanitation became well established the burdens of associated disease dropped and importantly the public expectations regarding the acceptability of poor sanitation and disease altered so that providing poor services has become politically very difficult

Label: 6, with a score of: 0.766396221728892
WordScorePoS
result0.0683326727248364NN
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Label: 3, with a score of: 0.38207068234851
WordScorePoS
result0NN
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Label: 1, with a score of: 0.312212827553633
WordScorePoS
result0NN
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Label: 17, with a score of: 0.219877690407736
WordScorePoS
result0NN
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mechanism0.147846224719512NN
ensure0.00335331148065841VB
environmental0JJ
sanitation0NN
establish0.048933054487825VB
burden0.036961556179878NN
disease0NN
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poor0.0153248097886055JJ
provide0.00601568197638796VB
service0NN

As mentioned earlier recent decades have seen some significant unraveling of the coherence of the systems put in place over the previous decades

Label: 17, with a score of: 0.393985566309915
WordScorePoS
decade0NN
significant0JJ
coherence0.146799163463475NN
system0.0211360962287062NN
previous0JJ

Label: 13, with a score of: 0.792091621714115
WordScorePoS
decade0.124232265906675NN
significant0.0343390275626203JJ
coherence0NN
system0NN
previous0.0548233071065585JJ

Environmental health has become disconnected from the mainstream agendas of the health agencies which now focus more on case management perspective and the newly formed environmental protection agencies which focus more on environmental regulation and compliance Kotchian

Label: 3, with a score of: 0.431354072431949
WordScorePoS
environmental0JJ
health0.191387734041787NN
agenda0NN
agency0NN
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newly0RB
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protection0.020806307400253NN
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Label: 16, with a score of: 0.247869277242501
WordScorePoS
environmental0JJ
health0NN
agenda0.0811931365363091NN
agency0NN
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newly0RB
form0.158049144643351NN
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Label: 1, with a score of: 0.356281838625571
WordScorePoS
environmental0.0442083771593746JJ
health0NN
agenda0NN
agency0NN
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newly0RB
form0.0884167543187491NN
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Label: 10, with a score of: 0.327619224995375
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
agenda0NN
agency0NN
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perspective0NN
newly0RB
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Correspondingly donor initiatives related to environmental health issues have also become highly compartmentalized

Label: 3, with a score of: 0.697376157361796
WordScorePoS
initiative0NN
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environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
highly0RB

Label: 12, with a score of: 0.311263385085339
WordScorePoS
initiative0NN
related0.00833571598658786JJ
environmental0.0598270388037045JJ
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issue0NN
highly0RB

With donor funding being channeled through separate sector silos of environment water and sanitation and health the possibility of generating the intersectoral coordination that is so APPROACHES TO ENVIRONMENTAL HEALTH crucial for environmental health initiatives was more or less preempted

Label: 6, with a score of: 0.652778460285093
WordScorePoS
sector0.0214003646985842NN
environment0NN
water0.556409482163189NN
sanitation0.334686906581616NN
health0NN
generate0VB
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environmental0JJ
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Label: 3, with a score of: 0.455969234954976
WordScorePoS
sector0NN
environment0NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
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generate0VB
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Label: 12, with a score of: 0.400257210309279
WordScorePoS
sector0.0169905820958638NN
environment0.079769385071606NN
water0.186896403054502NN
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generate0VB
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environmental0.0598270388037045JJ
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This development is also evidenced in the way that international goals and development initiatives addressing health give very little attention to the role of environmental sanitation

Label: 6, with a score of: 0.554562624074992
WordScorePoS
development0NN
evidence0NN
international0.00301873916506525JJ
goal0NN
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sanitation0.334686906581616NN

Label: 10, with a score of: 0.495613286189823
WordScorePoS
development0.0177346522508396NN
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environmental0.0237821918091848JJ
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Label: 3, with a score of: 0.340565470809681
WordScorePoS
development0.00837573444202498NN
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Sanitation was excluded from the list of the original Millennium Development Goals and was only subsequently introduced Satterthwaite von Schirnding

Label: 6, with a score of: 0.877524372952566
WordScorePoS
sanitation0.334686906581616NN
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Developing Countries Follow Suit As the world poorer countries have moved along the development path with increasing investments in infrastructure education health and other growthoriented sectors similar trend has been seen with government investments and donor funding increasingly programmed along sectoral lines

Label: 9, with a score of: 0.584395228436038
WordScorePoS
develop0VB
country0NN
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development0.0330049940546426NN
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line0.030745604615229NN

Label: 4, with a score of: 0.361009086224056
WordScorePoS
develop0VB
country0NN
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sector0NN
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Label: 3, with a score of: 0.288354630848272
WordScorePoS
develop0VB
country0NN
world0.00087176582269799NN
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development0.00837573444202498NN
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The role for the health sector is primarily that of regulation for example urban drinking water quality promotion for example hygiene promotion and advocacy for example persuading utilities to lower their connection charges to the poor

Label: 6, with a score of: 0.80648298410212
WordScorePoS
health0NN
sector0.0214003646985842NN
primarily0RB
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urban0JJ
drinking0.206460189193271NN
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Label: 11, with a score of: 0.304442837154294
WordScorePoS
health0.0229054731708393NN
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Label: 12, with a score of: 0.233128806934303
WordScorePoS
health0.0339811641917276NN
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drinking0NN
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poor0.0339811641917276JJ

Label: 3, with a score of: 0.195431112944138
WordScorePoS
health0.191387734041787NN
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Label: 1, with a score of: 0.12021415936519
WordScorePoS
health0NN
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drinking0NN
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poor0.150659516460257JJ

In some cases as in India see box

Label: 0, with a score of: 1

attention by the health department to environmental health functions has atrophied over the years as increased emphasis on treatment and delivery of health services led to dwindling role for public health issues BOX

Label: 3, with a score of: 0.797674333921989
WordScorePoS
attention0NN
health0.191387734041787NN
environmental0JJ
function0NN
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Atrophy of Environmental Health Functions in India The role of health departments in the stewardship of sanitation and public health activities has atrophied in India since the s

Label: 3, with a score of: 0.707486747130755
WordScorePoS
environmental0JJ
health0.191387734041787NN
function0NN
sanitation0.0249430985430622NN
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Label: 6, with a score of: 0.438684031273617
WordScorePoS
environmental0JJ
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Before independence sanitary departments existed at national and provincial levels with sanitary inspectors and other staff members on the ground in each district

Label: 0, with a score of: 1

In the districts sanitary inspectors worked with the village officials and village panchayats which had been set up to extend the bare bones of government to rural areas

Label: 2, with a score of: 0.484618018165529
WordScorePoS
official0NN
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rural0.148975141598503JJ

Label: 17, with a score of: 0.718012352441451
WordScorePoS
official0.0739231123597559NN
set0.0978661089756501NN
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Label: 10, with a score of: 0.476920557380565
WordScorePoS
official0.0488696285210061NN
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The municipal areas also had extensive machinery for environmental sanitation and public health activities including the management of water solid waste and liquid waste

Label: 6, with a score of: 0.747433716456601
WordScorePoS
municipal0JJ
environmental0JJ
sanitation0.334686906581616NN
public0NN
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activity0.0502364757923669NN
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waste0NN

Label: 12, with a score of: 0.486494781595083
WordScorePoS
municipal0JJ
environmental0.0598270388037045JJ
sanitation0NN
public0.028867295332595NN
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activity0.0199423462679015NN
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Label: 3, with a score of: 0.219525534378337
WordScorePoS
municipal0JJ
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sanitation0.0249430985430622NN
public0.021678073222951NN
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management0.0127591822694525NN
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Label: 11, with a score of: 0.301834017916796
WordScorePoS
municipal0.0731385760866977JJ
environmental0.0537696560159885JJ
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activity0NN
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Sanitary departments were accountable directly to the government and were administratively separate from the Indian Medical Service which provided medical services

Label: 16, with a score of: 0.670368780867278
WordScorePoS
accountable0.162386273072618JJ
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In the public health services were merged with the medical services into unified health department

Label: 3, with a score of: 0.748583902407987
WordScorePoS
public0.021678073222951NN
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Label: 5, with a score of: 0.40880209181732
WordScorePoS
public0.0727679293221751NN
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Interest in specializing in public health dwindled as specialty curative skills became far better rewarded

Label: 4, with a score of: 0.818768756144415
WordScorePoS
public0NN
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Label: 3, with a score of: 0.428065716630451
WordScorePoS
public0.021678073222951NN
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This atrophy was further fueled by strong electoral demand for services to cure the sick while by contrast public health services remained low profile because their success depended on ensuring no outbreaks

Label: 3, with a score of: 0.462945560441968
WordScorePoS
fuel0NN
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Label: 5, with a score of: 0.4289490513854
WordScorePoS
fuel0.0558185411034276NN
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Source Das Gupta and others

Label: 6, with a score of: 0.73415387760794
WordScorePoS
source0.0613562156822703NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Das Gupta and others

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
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One cause for atrophy is the lack of demand for environmental health services

Label: 3, with a score of: 0.559117574899665
WordScorePoS
lack0NN
demand0.020806307400253NN
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Label: 1, with a score of: 0.41238172405446
WordScorePoS
lack0.0753297582301286NN
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Label: 9, with a score of: 0.40748975127714
WordScorePoS
lack0.0565629593551219NN
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Label: 11, with a score of: 0.318431691604644
WordScorePoS
lack0.0229054731708393NN
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environmental0.0537696560159885JJ
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The public demands curative care over preventive care and environmental health is the most invisible type of preventive care

Label: 3, with a score of: 0.686570124549977
WordScorePoS
public0.021678073222951NN
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Label: 5, with a score of: 0.60123380991992
WordScorePoS
public0.0727679293221751NN
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care0.0931221694711702NN
environmental0JJ
health0.0571058915334038NN
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The consequences of such compartmentalization are much more severe than in the developed world where intensive environmental sanitation measures had become fundamental to public administration by the middle of the th century

Label: 6, with a score of: 0.579751216426889
WordScorePoS
develop0VB
world0.00438651305628668NN
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Label: 13, with a score of: 0.502433744946498
WordScorePoS
develop0VB
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measure0.0710409787438328NN
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This subsequent compartmentalization may create inefficiencies and the reemergence of some threats but the fundamental protections for public health remain firmly in place

Label: 3, with a score of: 0.466636260873674
WordScorePoS
create0VB
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Label: 5, with a score of: 0.463406593367631
WordScorePoS
create0VB
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protection0.0465610847355851NN
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Label: 10, with a score of: 0.455175308155616
WordScorePoS
create0VB
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Label: 1, with a score of: 0.348746728100849
WordScorePoS
create0.0519476926891779VB
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protection0.122839698738001NN
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By contrast the era of compartmentalization arrived for many developing countries at time when levels of exposure to environment related infections were still very high and before public health consciousness was intrinsically found in communities

Label: 3, with a score of: 0.649537031821438
WordScorePoS
develop0VB
country0NN
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infection0.122222546933424NN
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Label: 12, with a score of: 0.342401057601738
WordScorePoS
develop0VB
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time0.0169905820958638NN
level0.00513687014008325NN
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Box

Label: 0, with a score of: 1

illustrates the evolution of environmental health institutions in Ethiopia an example of such compartmentalization

Label: 16, with a score of: 0.669557288687655
WordScorePoS
environmental0JJ
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institution0.274477239401321NN

Label: 3, with a score of: 0.466869502814142
WordScorePoS
environmental0JJ
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institution0NN

Label: 10, with a score of: 0.398669643426684
WordScorePoS
environmental0.0237821918091848JJ
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BOX

Label: 0, with a score of: 1

Institutional Evolution of Environmental Health The Case of Ethiopia Traditional Organization The development of environmental health interventions in Ethiopia dates back to when it was organized under the Ministry of Interior

Label: 3, with a score of: 0.695652241720746
WordScorePoS
institutional0JJ
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health0.191387734041787NN
traditional0JJ
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The Ministry of Interior consolidated decision making power over health matters by proclaiming series of legal notices following its mandate in sanitation

Label: 6, with a score of: 0.700762482467333
WordScorePoS
decision0NN
power0NN
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sanitation0.334686906581616NN

Label: 3, with a score of: 0.452950289644558
WordScorePoS
decision0NN
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health0.191387734041787NN
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sanitation0.0249430985430622NN

Label: 9, with a score of: 0.328515041955084
WordScorePoS
decision0NN
power0.0454743001434393NN
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legal0JJ
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sanitation0.0737171311497939NN

During this period environmental health activities had an urban bias the institutionalized aspect did not reach the grassroots level to address environmental health and interventions were not significant because of limited human resources and unclear vision

Label: 11, with a score of: 0.523970094141137
WordScorePoS
period0NN
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vision0NN

Label: 3, with a score of: 0.480929170762002
WordScorePoS
period0NN
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vision0NN

Label: 12, with a score of: 0.348795880291773
WordScorePoS
period0.0409791940864438NN
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vision0NN

Label: 1, with a score of: 0.341506336284581
WordScorePoS
period0NN
environmental0.0442083771593746JJ
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New Organization New Tasks In the Ministry of Public Health was established with clear mandate and rural service provision began to promote medical and sanitation services

Label: 6, with a score of: 0.502642367769495
WordScorePoS
organization0NN
public0NN
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service0.0084006124696649NN
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sanitation0.334686906581616NN

Label: 3, with a score of: 0.441824731920391
WordScorePoS
organization0.0175975629039954NN
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Label: 2, with a score of: 0.348933314361911
WordScorePoS
organization0NN
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Label: 5, with a score of: 0.338595761075289
WordScorePoS
organization0NN
public0.0727679293221751NN
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sanitation0NN

The ministry set up hygiene and environmental health unit for the control and prevention of communicable diseases with senior sanitarian guiding sanitation activities

Label: 3, with a score of: 0.692576214633983
WordScorePoS
set0NN
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environmental0JJ
health0.191387734041787NN
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disease0.215415047323213NN
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activity0NN

Label: 6, with a score of: 0.648684746182734
WordScorePoS
set0NN
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disease0.103230094596636NN
sanitation0.334686906581616NN
activity0.0502364757923669NN

A series of sanitation regulations was enacted and training center was set up to train sanitarians who were largely involved in urban inspections pursuant to sanitation regulations

Label: 6, with a score of: 0.799714227556192
WordScorePoS
sanitation0.334686906581616NN
regulation0NN
training0NN
set0NN
involve0VB
urban0JJ

Label: 11, with a score of: 0.330012607439048
WordScorePoS
sanitation0NN
regulation0NN
training0NN
set0NN
involve0VB
urban0.27622591898666JJ

Label: 10, with a score of: 0.350313111643381
WordScorePoS
sanitation0NN
regulation0.0977392570420122NN
training0NN
set0NN
involve0.0488696285210061VB
urban0.0488696285210061JJ

They were key actors in the eradication of smallpox in Ethiopia

Label: 7, with a score of: 0.441847055790436
WordScorePoS
key0.0625160381065121NN
actor0NN
eradication0NN

Label: 1, with a score of: 0.4340994796335
WordScorePoS
key0NN
actor0NN
eradication0.0614198493690006NN

Label: 2, with a score of: 0.421166981753472
WordScorePoS
key0.0297950283197006NN
actor0NN
eradication0.0297950283197006NN

Label: 12, with a score of: 0.383438758226555
WordScorePoS
key0NN
actor0.0542519672965169NN
eradication0NN

Label: 15, with a score of: 0.37346630396615
WordScorePoS
key0.0528409850971592NN
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eradication0NN

continued APPROACHES TO ENVIRONMENTAL HEALTH Primary Health Care Emerges Late Late By the late socialist regime set up primary health care which included drinking water and sanitation as formal components

Label: 6, with a score of: 0.645272987920666
WordScorePoS
continue0VB
approach0NN
environmental0JJ
health0NN
primary0JJ
care0NN
emerge0VB
regime0NN
set0NN
include0VB
drinking0.206460189193271NN
water0.556409482163189NN
sanitation0.334686906581616NN

Label: 3, with a score of: 0.533750439255812
WordScorePoS
continue0VB
approach0NN
environmental0JJ
health0.191387734041787NN
primary0.0108390366114755JJ
care0.104031537001265NN
emerge0.0407408489778079VB
regime0NN
set0NN
include0VB
drinking0NN
water0.0382775468083574NN
sanitation0.0249430985430622NN

Label: 12, with a score of: 0.248607631220266
WordScorePoS
continue0.0199423462679015VB
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
primary0JJ
care0NN
emerge0VB
regime0NN
set0NN
include0VB
drinking0NN
water0.186896403054502NN
sanitation0NN

Label: 5, with a score of: 0.344004346109815
WordScorePoS
continue0.0335134328085675VB
approach0NN
environmental0JJ
health0.0571058915334038NN
primary0.0970239057629001JJ
care0.0931221694711702NN
emerge0VB
regime0NN
set0NN
include0VB
drinking0NN
water0NN
sanitation0NN

A year plan was made with rural and urban programs used as entry points for sanitation efforts

Label: 11, with a score of: 0.692470664078301
WordScorePoS
plan0.0583751976558017NN
rural0.0373517915079663JJ
urban0.27622591898666JJ
sanitation0NN
effort0.0229054731708393NN

Label: 6, with a score of: 0.586946802758422
WordScorePoS
plan0NN
rural0JJ
urban0JJ
sanitation0.334686906581616NN
effort0NN

Label: 2, with a score of: 0.261260543308412
WordScorePoS
plan0NN
rural0.148975141598503JJ
urban0JJ
sanitation0NN
effort0NN

Organized committees at various levels coordinated and ran environmental health interventions

Label: 3, with a score of: 0.649811730742489
WordScorePoS
organize0VB
level0NN
coordinate0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN

Label: 16, with a score of: 0.471853891207063
WordScorePoS
organize0.107490825192354VB
level0.0610668815653026NN
coordinate0NN
environmental0JJ
health0NN
intervention0NN

The Ministry of Public Health was renamed the Ministry of Health and in its Department of Hygiene and Environmental Health was organized into four divisions responsible for major sanitation activities water and sanitation food hygiene industrial hygiene and quarantine hygiene services

Label: 6, with a score of: 0.81606883283596
WordScorePoS
public0NN
health0NN
hygiene0.136665345449673NN
environmental0JJ
organize0VB
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major0JJ
sanitation0.334686906581616NN
activity0.0502364757923669NN
water0.556409482163189NN
food0.0214003646985842NN
industrial0JJ
service0.0084006124696649NN

Label: 3, with a score of: 0.310510543014764
WordScorePoS
public0.021678073222951NN
health0.191387734041787NN
hygiene0NN
environmental0JJ
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major0.0108390366114755JJ
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activity0NN
water0.0382775468083574NN
food0NN
industrial0JJ
service0.0100171139310145NN

Label: 9, with a score of: 0.310311472651622
WordScorePoS
public0.0160169090870187NN
health0.0377086395700813NN
hygiene0NN
environmental0.0221298700466866JJ
organize0VB
responsible0JJ
major0.0160169090870187JJ
sanitation0.0737171311497939NN
activity0NN
water0.0377086395700813NN
food0.0188543197850406NN
industrial0.318320101004075JJ
service0.0148023490369527NN

Label: 12, with a score of: 0.260370341960615
WordScorePoS
public0.028867295332595NN
health0.0339811641917276NN
hygiene0NN
environmental0.0598270388037045JJ
organize0VB
responsible0JJ
major0JJ
sanitation0NN
activity0.0199423462679015NN
water0.186896403054502NN
food0.186896403054502NN
industrial0JJ
service0.00666957305782837NN

Label: 2, with a score of: 0.135103962687005
WordScorePoS
public0NN
health0NN
hygiene0NN
environmental0JJ
organize0VB
responsible0JJ
major0JJ
sanitation0NN
activity0NN
water0NN
food0.292342270824999NN
industrial0JJ
service0.0143446978608332NN

Restructuring of Health Policy and Shift in Strategy Present The beginning of the brought decentralization of powers down to the grassroots level and expansion of the private sector in environmental health services

Label: 3, with a score of: 0.497160234533689
WordScorePoS
restructuring0NN
health0.191387734041787NN
policy0NN
strategy0.0149758277542848NN
bring0VB
power0NN
level0NN
expansion0NN
private0JJ
sector0NN
environmental0JJ
service0.0100171139310145NN

Label: 17, with a score of: 0.372853565091992
WordScorePoS
restructuring0.036961556179878NN
health0NN
policy0.0641521854453136NN
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bring0VB
power0.036961556179878NN
level0.0138997399903163NN
expansion0NN
private0.0898760357768464JJ
sector0.0459744293658165NN
environmental0JJ
service0NN

Label: 5, with a score of: 0.366947699467205
WordScorePoS
restructuring0NN
health0.0571058915334038NN
policy0.0341506708422088NN
strategy0NN
bring0VB
power0NN
level0.0172651853471334NN
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private0.0558185411034276JJ
sector0.0571058915334038NN
environmental0JJ
service0.022416649027415NN

Label: 11, with a score of: 0.357787087872691
WordScorePoS
restructuring0NN
health0.0229054731708393NN
policy0.0136980135278128NN
strategy0NN
bring0.0731385760866977VB
power0NN
level0.00692515656684925NN
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private0JJ
sector0NN
environmental0.0537696560159885JJ
service0.0269743071558856NN

Label: 9, with a score of: 0.320070965624893
WordScorePoS
restructuring0NN
health0.0377086395700813NN
policy0.011275328195446NN
strategy0NN
bring0VB
power0.0454743001434393NN
level0NN
expansion0NN
private0.0368585655748969JJ
sector0.0565629593551219NN
environmental0.0221298700466866JJ
service0.0148023490369527NN

Although the Department of Hygiene and Environmental Health maintained its status regional states developed teams of environmental health professionals organized under the Department of Disease Prevention and Control or Department of Health Programs

Label: 3, with a score of: 0.818172947751285
WordScorePoS
hygiene0NN
environmental0JJ
health0.191387734041787NN
maintain0VB
status0NN
regional0JJ
develop0VB
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disease0.215415047323213NN
prevention0.0923207345670913NN
control0.020806307400253NN

Label: 6, with a score of: 0.217430828423433
WordScorePoS
hygiene0.136665345449673NN
environmental0JJ
health0NN
maintain0VB
status0NN
regional0JJ
develop0VB
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disease0.103230094596636NN
prevention0NN
control0NN

Environmental health personnel worked in administrative units that coordinated and guided socioeconomic development at the grassroots levels

Label: 3, with a score of: 0.568214108050172
WordScorePoS
environmental0JJ
health0.191387734041787NN
coordinate0NN
development0.00837573444202498NN
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Label: 12, with a score of: 0.344893166704714
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
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development0.022306853314744NN
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Health extension packages targeted households with strong focus on community based approaches and sustained preventive and promotional health care

Label: 3, with a score of: 0.668078794774235
WordScorePoS
health0.191387734041787NN
extension0NN
target0NN
household0NN
strong0JJ
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community0NN
base0.0149758277542848NN
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care0.104031537001265NN

Label: 9, with a score of: 0.428238911922754
WordScorePoS
health0.0377086395700813NN
extension0NN
target0NN
household0NN
strong0.0454743001434393JJ
focus0.030745604615229NN
community0.0188543197850406NN
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sustained0.120405991343299JJ
care0.030745604615229NN

Label: 5, with a score of: 0.338038448906568
WordScorePoS
health0.0571058915334038NN
extension0NN
target0NN
household0.0465610847355851NN
strong0JJ
focus0NN
community0NN
base0NN
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sustained0JJ
care0.0931221694711702NN

Ethiopia is clear case of how an environmental health institutional framework has evolved over the years

Label: 3, with a score of: 0.629495301982568
WordScorePoS
environmental0JJ
health0.191387734041787NN
institutional0JJ
framework0.0108390366114755NN

Label: 12, with a score of: 0.381866602608568
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
institutional0JJ
framework0.028867295332595NN

Label: 13, with a score of: 0.348613341526258
WordScorePoS
environmental0JJ
health0NN
institutional0.0828215106044499JJ
framework0.0291713033871158NN

In the most recent past success has been largely due to the use of local government as platform for environmental health including hygiene promotion

Label: 6, with a score of: 0.471298322505365
WordScorePoS
due0.0590310971343993JJ
local0.0181797964452808JJ
government0NN
platform0NN
environmental0JJ
health0NN
include0VB
hygiene0.136665345449673NN
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Label: 3, with a score of: 0.421742585391254
WordScorePoS
due0JJ
local0JJ
government0NN
platform0NN
environmental0JJ
health0.191387734041787NN
include0VB
hygiene0NN
promotion0NN

Label: 5, with a score of: 0.531948359650754
WordScorePoS
due0JJ
local0JJ
government0NN
platform0.0911713013253052NN
environmental0JJ
health0.0571058915334038NN
include0VB
hygiene0NN
promotion0.0931221694711702NN

Source Kumie and Ahmed

Label: 6, with a score of: 0.73415387760794
WordScorePoS
source0.0613562156822703NN

Compartmentalization at the national level means that the basic institutional mechanisms for successful governance of environmental sanitation are lacking at local levels

Label: 6, with a score of: 0.520275628961328
WordScorePoS
national0JJ
level0.00647010760354177NN
means0NNS
basic0.0181797964452808JJ
institutional0JJ
mechanism0NN
successful0JJ
governance0NN
environmental0JJ
sanitation0.334686906581616NN
lack0.0214003646985842NN
local0.0181797964452808JJ

Label: 17, with a score of: 0.369584734991611
WordScorePoS
national0.0134132459226336JJ
level0.0138997399903163NN
means0NNS
basic0JJ
institutional0.036961556179878JJ
mechanism0.147846224719512NN
successful0.048933054487825JJ
governance0NN
environmental0JJ
sanitation0NN
lack0NN
local0.0130185595639838JJ

Label: 1, with a score of: 0.440279575154604
WordScorePoS
national0.0164833460638534JJ
level0.0113874611101829NN
means0.120266261535276NNS
basic0.0639932865717261JJ
institutional0JJ
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environmental0.0442083771593746JJ
sanitation0NN
lack0.0753297582301286NN
local0JJ

Label: 16, with a score of: 0.332516457183808
WordScorePoS
national0.0294647633960925JJ
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basic0JJ
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governance0.107490825192354NN
environmental0JJ
sanitation0NN
lack0NN
local0JJ

The consequences can be devastating

Label: 0, with a score of: 1

In Ghana government program for expanding irrigation through the construction of dams and canals supported by the U

Label: 6, with a score of: 0.521560625804592
WordScorePoS
government0NN
expand0.0251182378961834VB
irrigation0.0516150472983178NN
support0.0209983814716066NN

Label: 17, with a score of: 0.501880285798568
WordScorePoS
government0.048933054487825NN
expand0VB
irrigation0NN
support0.0451108483130998NN

Agency for International Development started as well designed effort to make water available for use by humans and livestock as well as for agriculture and fishing Hunter

Label: 6, with a score of: 0.725981766303667
WordScorePoS
agency0NN
international0.00301873916506525JJ
development0NN
effort0NN
water0.556409482163189NN
human0.0127979231406811JJ
livestock0NN
agriculture0NN
fishing0NN

Label: 12, with a score of: 0.385327613348298
WordScorePoS
agency0.0542519672965169NN
international0.0023966944644375JJ
development0.022306853314744NN
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water0.186896403054502NN
human0.0101607690729067JJ
livestock0NN
agriculture0.0277064208763707NN
fishing0NN

Label: 14, with a score of: 0.36925156753579
WordScorePoS
agency0NN
international0.00470029406779661JJ
development0.0036456034155327NN
effort0.0166605993001162NN
water0.0333211986002325NN
human0.0199268631468397JJ
livestock0NN
agriculture0NN
fishing0.212793248229045NN

Label: 2, with a score of: 0.28985143992783
WordScorePoS
agency0NN
international0.00515473144367677JJ
development0.0159922815774215NN
effort0NN
water0NN
human0JJ
livestock0.0583416713841148NN
agriculture0.148975141598503NN
fishing0NN

However no measures were in place to protect against the spread of water related diseases

Label: 6, with a score of: 0.853567471301474
WordScorePoS
measure0NN
protect0.0153390539205676VB
spread0NN
water0.556409482163189NN
related0.0524959536790166JJ
disease0.103230094596636NN

Label: 3, with a score of: 0.370887502204759
WordScorePoS
measure0NN
protect0.00914534810831654VB
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water0.0382775468083574NN
related0.0125195145191824JJ
disease0.215415047323213NN

Label: 12, with a score of: 0.243360753101485
WordScorePoS
measure0NN
protect0.0121782716594324VB
spread0NN
water0.186896403054502NN
related0.00833571598658786JJ
disease0NN

Poor maintenance and absence of community extension services to encourage dredging repairs and vector control resulted in an increase in cases not only of schistosomiasis in children but also of filariasis among adults

Label: 1, with a score of: 0.51654556163304
WordScorePoS
poor0.150659516460257JJ
community0NN
extension0NN
service0.0443555132287109NN
encourage0VB
control0.0614198493690006NN
result0NN
increase0NN
child0.0450489732120807NN
adult0JJ

Label: 4, with a score of: 0.434749722231021
WordScorePoS
poor0JJ
community0NN
extension0NN
service0NN
encourage0VB
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result0NN
increase0.0144029596227568NN
child0.076326555629389NN
adult0.163013873070017JJ

Label: 2, with a score of: 0.365443234104318
WordScorePoS
poor0.0548141757796873JJ
community0.0182713919265625NN
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increase0.0128868286091919NN
child0.0546336178945768NN
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Label: 6, with a score of: 0.337506173167553
WordScorePoS
poor0.0642010940957526JJ
community0.0214003646985842NN
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encourage0VB
control0NN
result0.0683326727248364NN
increase0.00905621749519576NN
child0.0255958462813622NN
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The water supply project is described as classic example ENVIRONMENTAL HEALTH AND CHILD SURVIVAL of un coordinated unisectoral intervention by the Ministry of Agriculture and its international collaborators Hunter

Label: 6, with a score of: 0.695687571469137
WordScorePoS
water0.556409482163189NN
supply0.0590310971343993NN
project0.041835863322702NN
environmental0JJ
health0NN
child0.0255958462813622NN
coordinate0NN
intervention0NN
agriculture0NN
international0.00301873916506525JJ

Label: 12, with a score of: 0.453930755943015
WordScorePoS
water0.186896403054502NN
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child0NN
coordinate0NN
intervention0NN
agriculture0.0277064208763707NN
international0.0023966944644375JJ

Label: 3, with a score of: 0.382618177682525
WordScorePoS
water0.0382775468083574NN
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project0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
coordinate0NN
intervention0.0407408489778079NN
agriculture0NN
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Label: 2, with a score of: 0.211745248265712
WordScorePoS
water0NN
supply0NN
project0NN
environmental0JJ
health0NN
child0.0546336178945768NN
coordinate0NN
intervention0NN
agriculture0.148975141598503NN
international0.00515473144367677JJ

Institutional Requirements for Successful Environmental Health Governance Successful environmental health governance requires strong institutional underpinnings with clearly articulated roles at all levels of administration within country

Label: 3, with a score of: 0.52067176648929
WordScorePoS
institutional0JJ
successful0JJ
environmental0JJ
health0.191387734041787NN
governance0NN
require0VB
strong0JJ
level0NN
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Because developing countries differ in their level of institutional complexity this section talks in more general terms about the typical roles and responsibilities that should exist in countries for effective governance but it caters to the more specific case of environmental health governance

Label: 17, with a score of: 0.468142835689544
WordScorePoS
develop0VB
country0NN
level0.0138997399903163NN
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Label: 3, with a score of: 0.332264136715404
WordScorePoS
develop0VB
country0NN
level0NN
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effective0.00914534810831654JJ
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specific0JJ
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health0.191387734041787NN

Label: 16, with a score of: 0.537345316837626
WordScorePoS
develop0VB
country0NN
level0.0610668815653026NN
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specific0JJ
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Roles of National Governments Successful environmental health governance is not possible without strong involvement at the national level

Label: 3, with a score of: 0.46475423589404
WordScorePoS
national0.00558382296134999JJ
government0NN
successful0JJ
environmental0JJ
health0.191387734041787NN
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Label: 16, with a score of: 0.521959255896545
WordScorePoS
national0.0294647633960925JJ
government0NN
successful0JJ
environmental0JJ
health0NN
governance0.107490825192354NN
strong0JJ
level0.0610668815653026NN

Label: 17, with a score of: 0.31799391092838
WordScorePoS
national0.0134132459226336JJ
government0.048933054487825NN
successful0.048933054487825JJ
environmental0JJ
health0NN
governance0NN
strong0JJ
level0.0138997399903163NN

Label: 10, with a score of: 0.30036854524346
WordScorePoS
national0.00886732612541978JJ
government0NN
successful0JJ
environmental0.0237821918091848JJ
health0.0405241466500776NN
governance0NN
strong0.0488696285210061JJ
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Provide the regulatory framework

Label: 1, with a score of: 0.500264624708983
WordScorePoS
provide0.0295703421524739VB
framework0.0319966432858631NN

Label: 12, with a score of: 0.397143710709112
WordScorePoS
provide0.0200087191734851VB
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Label: 11, with a score of: 0.377290527760525
WordScorePoS
provide0.0269743071558856VB
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Label: 15, with a score of: 0.361749934438505
WordScorePoS
provide0.0445201436316848VB
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Label: 8, with a score of: 0.347945710631033
WordScorePoS
provide0VB
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An appropriate legal and regulatory framework should underpin effective environmental health action

Label: 3, with a score of: 0.53692569459479
WordScorePoS
legal0JJ
framework0.0108390366114755NN
effective0.00914534810831654JJ
environmental0JJ
health0.191387734041787NN
action0NN

Label: 12, with a score of: 0.342554422709434
WordScorePoS
legal0JJ
framework0.028867295332595NN
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environmental0.0598270388037045JJ
health0.0339811641917276NN
action0.0121782716594324NN

Label: 16, with a score of: 0.328831330450093
WordScorePoS
legal0.0811931365363091JJ
framework0NN
effective0.0482582488828229JJ
environmental0JJ
health0NN
action0NN

Label: 5, with a score of: 0.301020927904641
WordScorePoS
legal0JJ
framework0NN
effective0.02046578088155JJ
environmental0JJ
health0.0571058915334038NN
action0.0409315617631NN

Many countries have such regulations but many do not have adequate implementation mechanisms

Label: 17, with a score of: 0.728896705479095
WordScorePoS
country0NN
regulation0.036961556179878NN
adequate0JJ
implementation0.017987180284335NN
mechanism0.147846224719512NN

Label: 10, with a score of: 0.522258266937504
WordScorePoS
country0NN
regulation0.0977392570420122NN
adequate0JJ
implementation0.0475643836183697NN
mechanism0NN

In several African countries for example an examination of their legislation reveals an encouraging picture with many countries having environmental health policies and sanitation codes WHO Regional Office for Africa but problems with implementation remain

Label: 6, with a score of: 0.495348730139377
WordScorePoS
african0IN
country0NN
legislation0NN
encourage0VB
environmental0JJ
health0NN
policy0NN
sanitation0.334686906581616NN
regional0JJ
africa0IN
implementation0NN
remain0VB

Label: 3, with a score of: 0.342342225580402
WordScorePoS
african0IN
country0NN
legislation0NN
encourage0VB
environmental0JJ
health0.191387734041787NN
policy0NN
sanitation0.0249430985430622NN
regional0JJ
africa0IN
implementation0.0149758277542848NN
remain0VB

Label: 10, with a score of: 0.44972071579388
WordScorePoS
african0IN
country0NN
legislation0.0396106020715138NN
encourage0.02794560829783VB
environmental0.0237821918091848JJ
health0.0405241466500776NN
policy0.0848203862485078NN
sanitation0NN
regional0JJ
africa0IN
implementation0.0475643836183697NN
remain0.0396106020715138VB

For example in Ethiopia issues with competing mandates but also other institutional weaknesses hinder implementation of reasonable policies

Label: 17, with a score of: 0.547078412838217
WordScorePoS
issue0.0299586785922821NN
mandate0NN
institutional0.036961556179878JJ
implementation0.017987180284335NN
policy0.0641521854453136NN

Label: 13, with a score of: 0.53880932086252
WordScorePoS
issue0.0335649154577099NN
mandate0NN
institutional0.0828215106044499JJ
implementation0.0201523636533764NN
policy0.0102677744436108NN

Label: 10, with a score of: 0.485878464311631
WordScorePoS
issue0NN
mandate0NN
institutional0JJ
implementation0.0475643836183697NN
policy0.0848203862485078NN

These regulations need to be backed by at least rudimentary implementation framework including mechanisms for building stakeholder compliance monitoring mechanisms and transparent enforcement mechanisms that minimize reliance on the overburdened judiciary

Label: 17, with a score of: 0.875930625156808
WordScorePoS
regulation0.036961556179878NN
implementation0.017987180284335NN
framework0.0130185595639838NN
include0VB
mechanism0.147846224719512NN
building0.149940347231585NN
stakeholder0.0739231123597559NN
monitor0.0599173571845643NN
transparent0.036961556179878JJ
minimize0VB
judiciary0NN

Label: 16, with a score of: 0.31414093001003
WordScorePoS
regulation0NN
implementation0NN
framework0NN
include0VB
mechanism0NN
building0.109790895760528NN
stakeholder0NN
monitor0NN
transparent0.0811931365363091JJ
minimize0VB
judiciary0.107490825192354NN

These implementation frameworks such as frameworks for ensuring the quality of public and private sources of drinking water will serve to guide local governments to engage in appropriate environmental health actions

Label: 6, with a score of: 0.6962283150696
WordScorePoS
implementation0NN
framework0NN
ensure0.00936547854413134VB
quality0.0255958462813622NN
public0NN
private0JJ
source0.0613562156822703NN
drinking0.206460189193271NN
water0.556409482163189NN
serve0VB
local0.0181797964452808JJ
government0NN
engage0VB
environmental0JJ
health0NN
action0NN

Label: 12, with a score of: 0.415480229952291
WordScorePoS
implementation0.0199423462679015NN
framework0.028867295332595NN
ensure0.00743561777158133VB
quality0.0203215381458133NN
public0.028867295332595NN
private0JJ
source0NN
drinking0NN
water0.186896403054502NN
serve0VB
local0.0144336476662975JJ
government0NN
engage0.0819583881728876VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
action0.0121782716594324NN

Label: 3, with a score of: 0.247294593821333
WordScorePoS
implementation0.0149758277542848NN
framework0.0108390366114755NN
ensure0.00837573444202498VB
quality0.0152605842304358NN
public0.021678073222951NN
private0JJ
source0NN
drinking0NN
water0.0382775468083574NN
serve0VB
local0JJ
government0NN
engage0VB
environmental0JJ
health0.191387734041787NN
action0NN

When necessary local governments can amend model bylaws framed by the national governments which can provide regulatory basis for local environmental health activities such as the maintenance and cleaning of drains and other civic amenities

Label: 3, with a score of: 0.459689957610785
WordScorePoS
local0JJ
government0NN
national0.00558382296134999JJ
provide0.0100171139310145VB
basis0NN
environmental0JJ
health0.191387734041787NN
activity0NN

Provide the necessary platforms for intersectoral coordination

Label: 17, with a score of: 0.64186555120617
WordScorePoS
provide0.00601568197638796VB
platform0NN
coordination0.0978661089756501NN

Label: 5, with a score of: 0.632583962686774
WordScorePoS
provide0.0112083245137075VB
platform0.0911713013253052NN
coordination0NN

Environmental health is intrinsically multisectoral and requires intersectoral coordination across health environment infrastructure and other sectors

Label: 9, with a score of: 0.528433237110341
WordScorePoS
environmental0.0221298700466866JJ
health0.0377086395700813NN
require0.0260040237236563VB
coordination0NN
environment0.0221298700466866NN
infrastructure0.192202909044225NN
sector0.0565629593551219NN

Label: 3, with a score of: 0.512797220265206
WordScorePoS
environmental0JJ
health0.191387734041787NN
require0VB
coordination0NN
environment0NN
infrastructure0NN
sector0NN

Label: 12, with a score of: 0.402284542243244
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
require0.0468670845659596VB
coordination0NN
environment0.079769385071606NN
infrastructure0.028867295332595NN
sector0.0169905820958638NN

In an era of sectoral ministries and silo mentality intersectoral coordination mechanisms such as intersectoral committees need to be established at each level of the administrative hierarchy down to local governments

Label: 17, with a score of: 0.939255251988482
WordScorePoS
coordination0.0978661089756501NN
mechanism0.147846224719512NN
establish0.048933054487825VB
level0.0138997399903163NN
local0.0130185595639838JJ
government0.048933054487825NN

These mechanisms must be set up to work on APPROACHES TO ENVIRONMENTAL HEALTH routine basis rather than in response to an emergency

Label: 17, with a score of: 0.705161408498763
WordScorePoS
mechanism0.147846224719512NN
set0.0978661089756501NN
approach0NN
environmental0JJ
health0NN
basis0.048933054487825NN
response0NN

Label: 3, with a score of: 0.458039560498663
WordScorePoS
mechanism0NN
set0NN
approach0NN
environmental0JJ
health0.191387734041787NN
basis0NN
response0NN

Label: 12, with a score of: 0.3543456725031
WordScorePoS
mechanism0NN
set0NN
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
basis0NN
response0NN

They must involve all key departments whose actions pertain to environmental sanitation and public health outcomes

Label: 6, with a score of: 0.545486704952268
WordScorePoS
involve0VB
key0NN
action0NN
environmental0JJ
sanitation0.334686906581616NN
public0NN
health0NN
outcome0NN

Label: 3, with a score of: 0.387916859683699
WordScorePoS
involve0VB
key0NN
action0NN
environmental0JJ
sanitation0.0249430985430622NN
public0.021678073222951NN
health0.191387734041787NN
outcome0NN

Label: 5, with a score of: 0.354272950965526
WordScorePoS
involve0VB
key0NN
action0.0409315617631NN
environmental0JJ
sanitation0NN
public0.0727679293221751NN
health0.0571058915334038NN
outcome0.0465610847355851NN

Label: 12, with a score of: 0.353369514679945
WordScorePoS
involve0.0819583881728876VB
key0NN
action0.0121782716594324NN
environmental0.0598270388037045JJ
sanitation0NN
public0.028867295332595NN
health0.0339811641917276NN
outcome0NN

Label: 9, with a score of: 0.315915965271658
WordScorePoS
involve0VB
key0NN
action0.0135141354781442NN
environmental0.0221298700466866JJ
sanitation0.0737171311497939NN
public0.0160169090870187NN
health0.0377086395700813NN
outcome0.030745604615229NN

In the Philippines for example the Interagency Committee on Environmental Health was established in mid the Department of Health serves as the chair and the Department of Environment and Natural Resources is the vice chair

Label: 3, with a score of: 0.602150881652036
WordScorePoS
environmental0JJ
health0.191387734041787NN
establish0VB
serve0VB
environment0NN
natural0JJ
resource0NN

Label: 12, with a score of: 0.472264228925937
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
establish0VB
serve0VB
environment0.079769385071606NN
natural0.0509717462875914JJ
resource0.0416785799329393NN

Label: 11, with a score of: 0.305690347917794
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
establish0VB
serve0VB
environment0.0268848280079943NN
natural0.0229054731708393JJ
resource0.0449504361447405NN

The committee has addressed priority environmental health problems in the country such as water quality and sanitation among other issues Blössner and de Onis

Label: 6, with a score of: 0.857369277292949
WordScorePoS
address0NN
priority0NN
environmental0JJ
health0NN
country0NN
water0.556409482163189NN
quality0.0255958462813622NN
sanitation0.334686906581616NN
issue0NN

Label: 12, with a score of: 0.31987275391829
WordScorePoS
address0NN
priority0.0409791940864438NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
country0NN
water0.186896403054502NN
quality0.0203215381458133NN
sanitation0NN
issue0NN

Label: 3, with a score of: 0.275733550497345
WordScorePoS
address0NN
priority0NN
environmental0JJ
health0.191387734041787NN
country0NN
water0.0382775468083574NN
quality0.0152605842304358NN
sanitation0.0249430985430622NN
issue0.0249430985430622NN

Ensure interjurisdictional coordination

Label: 17, with a score of: 0.846344518830613
WordScorePoS
ensure0.00335331148065841VB
coordination0.0978661089756501NN

Label: 4, with a score of: 0.326924538772408
WordScorePoS
ensure0.0390988676729552VB
coordination0NN

Environmental health exposures have significant public health externalities so inadequate attention to clean water and proper sanitation for example results in infections such as diarrhea which can cross jurisdictional boundaries

Label: 6, with a score of: 0.769088175516829
WordScorePoS
environmental0JJ
health0NN
exposure0NN
significant0JJ
public0NN
inadequate0.0836717266454039JJ
attention0.041835863322702NN
clean0.0348974218717993JJ
water0.556409482163189NN
proper0JJ
sanitation0.334686906581616NN
result0.0683326727248364NN
infection0NN

Label: 3, with a score of: 0.428186135089124
WordScorePoS
environmental0JJ
health0.191387734041787NN
exposure0NN
significant0.0127591822694525JJ
public0.021678073222951NN
inadequate0JJ
attention0NN
clean0.020806307400253JJ
water0.0382775468083574NN
proper0JJ
sanitation0.0249430985430622NN
result0NN
infection0.122222546933424NN

Label: 12, with a score of: 0.235947991486665
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
exposure0NN
significant0JJ
public0.028867295332595NN
inadequate0JJ
attention0NN
clean0JJ
water0.186896403054502NN
proper0JJ
sanitation0NN
result0NN
infection0NN

Label: 7, with a score of: 0.0858704817683959
WordScorePoS
environmental0JJ
health0NN
exposure0NN
significant0JJ
public0NN
inadequate0JJ
attention0NN
clean0.125032076213024JJ
water0NN
proper0JJ
sanitation0NN
result0NN
infection0NN

Interjurisdictional coordination therefore becomes essential because local governments efforts to reduce environmental exposures to infections can be seriously undermined if neighboring local authorities do not take similar action

Label: 3, with a score of: 0.456454818594892
WordScorePoS
coordination0NN
essential0.059903311017139JJ
local0JJ
government0NN
effort0.0127591822694525NN
reduce0.01675146888405VB
environmental0JJ
exposure0NN
infection0.122222546933424NN
action0NN

Label: 1, with a score of: 0.448514350664451
WordScorePoS
coordination0NN
essential0JJ
local0JJ
government0NN
effort0NN
reduce0.0164833460638534VB
environmental0.0442083771593746JJ
exposure0.120266261535276NN
infection0NN
action0.0269969049497485NN

Label: 17, with a score of: 0.403694180446482
WordScorePoS
coordination0.0978661089756501NN
essential0JJ
local0.0130185595639838JJ
government0.048933054487825NN
effort0NN
reduce0.00335331148065841VB
environmental0JJ
exposure0NN
infection0NN
action0.0109843026967392NN

Thus if peri urban area is poorly serviced it can be recurring source of disease outbreaks that can spread to the nearby metropolis

Label: 11, with a score of: 0.700128318824281
WordScorePoS
perus0.0731385760866977NN
urban0.27622591898666JJ
poorly0RB
service0.0269743071558856NN
recur0VB
source0NN
disease0NN
spread0NN

Label: 3, with a score of: 0.495179505983113
WordScorePoS
perus0NN
urban0JJ
poorly0RB
service0.0100171139310145NN
recur0VB
source0NN
disease0.215415047323213NN
spread0.0407408489778079NN

Label: 6, with a score of: 0.448943031325361
WordScorePoS
perus0NN
urban0JJ
poorly0RB
service0.0084006124696649NN
recur0.0683326727248364VB
source0.0613562156822703NN
disease0.103230094596636NN
spread0NN

Another set of issues arises because urban and rural local bodies have different regulatory organizational and implementation structures and they typically have very low levels of coordination with each other

Label: 11, with a score of: 0.605330983863983
WordScorePoS
set0NN
issue0NN
arise0VB
urban0.27622591898666JJ
rural0.0373517915079663JJ
local0.0194583992186006JJ
implementation0NN
structure0NN
typically0RB
level0.00692515656684925NN
coordination0NN

Label: 2, with a score of: 0.381204865690351
WordScorePoS
set0NN
issue0NN
arise0.0440683498519077VB
urban0JJ
rural0.148975141598503JJ
local0.0155217067874935JJ
implementation0NN
structure0NN
typically0RB
level0.00552410547653725NN
coordination0NN

Label: 17, with a score of: 0.568950300951968
WordScorePoS
set0.0978661089756501NN
issue0.0299586785922821NN
arise0VB
urban0JJ
rural0JJ
local0.0130185595639838JJ
implementation0.017987180284335NN
structure0.048933054487825NN
typically0RB
level0.0138997399903163NN
coordination0.0978661089756501NN

This situation greatly increases the probability of differential public health performance in neighboring localities and resultant externalities

Label: 3, with a score of: 0.572468586449912
WordScorePoS
situation0NN
increase0.0143984997539974NN
differential0JJ
public0.021678073222951NN
health0.191387734041787NN
performance0NN
resultant0JJ

Label: 10, with a score of: 0.438322519849031
WordScorePoS
situation0NN
increase0.00285817158600878NN
differential0.0488696285210061JJ
public0.0172128079963482NN
health0.0405241466500776NN
performance0.064698038783335NN
resultant0JJ

Label: 11, with a score of: 0.371708780812376
WordScorePoS
situation0.0631828116343571NN
increase0.00323105002784081NN
differential0JJ
public0.0583751976558017NN
health0.0229054731708393NN
performance0NN
resultant0JJ

Label: 5, with a score of: 0.336995311146799
WordScorePoS
situation0NN
increase0.00402768349408688NN
differential0JJ
public0.0727679293221751NN
health0.0571058915334038NN
performance0NN
resultant0JJ

Label: 12, with a score of: 0.318838792486547
WordScorePoS
situation0NN
increase0.00958677785775002NN
differential0JJ
public0.028867295332595NN
health0.0339811641917276NN
performance0NN
resultant0.0542519672965169JJ

Even within urban areas ignoring the growing slum settlements with dismal environmental conditions and almost negligent access to environmental services can derail attempts by city governments to provide healthy environments

Label: 11, with a score of: 0.937262019497606
WordScorePoS
urban0.27622591898666JJ
grow0.0229054731708393VB
slum0.146277152173395NN
settlement0.146277152173395NN
environmental0.0537696560159885JJ
condition0NN
access0.00626002771693937NN
service0.0269743071558856NN
city0.607697021770652NN
government0NN
provide0.0269743071558856VB
healthy0JJ
environment0.0268848280079943NN

Clarify mandates and appropriate devolution of authority and finances

Label: 2, with a score of: 1
WordScorePoS
mandate0.0583416713841148NN

Inappropriate devolution of authority is perennial issue in any country developed or developing and becomes an issue in the implementation of environmental health interventions

Label: 3, with a score of: 0.783907126688608
WordScorePoS
issue0.0249430985430622NN
country0NN
develop0VB
implementation0.0149758277542848NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN

For example Dandoy quotes former U

Label: 0, with a score of: 1

state health officer as saying The federal government has most of the money the state government has most of the legal authority and the local government has most of the responsibility for protecting the health of the people

Label: 3, with a score of: 0.680625856368833
WordScorePoS
health0.191387734041787NN
government0NN
money0NN
legal0JJ
local0JJ
responsibility0NN
protect0.00914534810831654VB
people0.00539943740774902NNS

Label: 16, with a score of: 0.364557526853276
WordScorePoS
health0NN
government0NN
money0.107490825192354NN
legal0.0811931365363091JJ
local0JJ
responsibility0NN
protect0.0241291244414115VB
people0NNS

Label: 5, with a score of: 0.351829629704487
WordScorePoS
health0.0571058915334038NN
government0NN
money0NN
legal0JJ
local0JJ
responsibility0.0911713013253052NN
protect0VB
people0NNS

Various institutional problems typically hamper effective environmental service delivery and reduce the scope for serious accountability

Label: 17, with a score of: 0.399188597699022
WordScorePoS
institutional0.036961556179878JJ
typically0RB
effective0.0219686053934784JJ
environmental0JJ
service0NN
reduce0.00335331148065841VB
accountability0.048933054487825NN

Label: 1, with a score of: 0.377045210260062
WordScorePoS
institutional0JJ
typically0RB
effective0JJ
environmental0.0442083771593746JJ
service0.0443555132287109NN
reduce0.0164833460638534VB
accountability0NN

Label: 11, with a score of: 0.361772952950931
WordScorePoS
institutional0JJ
typically0RB
effective0JJ
environmental0.0537696560159885JJ
service0.0269743071558856NN
reduce0.0200483235258943VB
accountability0NN

Problems relating to the decentralization of functions can result in delegation of environmental health functions to local governments without adequate administrative financial and technical support from line agencies or higher levels of government

Label: 3, with a score of: 0.318916054494733
WordScorePoS
function0NN
result0NN
environmental0JJ
health0.191387734041787NN
local0JJ
government0NN
adequate0JJ
financial0.00625975725959118JJ
technical0JJ
support0.00625975725959118NN
line0NN
agency0NN
level0NN

Label: 11, with a score of: 0.429571859601063
WordScorePoS
function0NN
result0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
local0.0194583992186006JJ
government0NN
adequate0.0631828116343571JJ
financial0.0112376090361851JJ
technical0.0373517915079663JJ
support0.0224752180723703NN
line0.0373517915079663NN
agency0NN
level0.00692515656684925NN

Label: 8, with a score of: 0.31692867159825
WordScorePoS
function0NN
result0NN
environmental0.0295821503613099JJ
health0NN
local0.0214106369326177JJ
government0NN
adequate0JJ
financial0.0370951943725875JJ
technical0.0410992516792148JJ
support0.024730129581725NN
line0.0410992516792148NN
agency0NN
level0.00761994916892276NN

Label: 12, with a score of: 0.311866520738701
WordScorePoS
function0NN
result0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
local0.0144336476662975JJ
government0NN
adequate0.0234335422829798JJ
financial0JJ
technical0JJ
support0.00833571598658786NN
line0NN
agency0.0542519672965169NN
level0.00513687014008325NN

In addition insufficient clarity and differentiation of mandates and functions between the different layers of the government hierarchy and line agencies creates confusion undermines accountability and leads to duplication of efforts and waste of resources

Label: 12, with a score of: 0.47966443101012
WordScorePoS
addition0NN
insufficient0JJ
mandate0NN
function0NN
government0NN
line0NN
agency0.0542519672965169NN
create0.0234335422829798VB
accountability0NN
lead0.0169905820958638NN
effort0NN
waste0.138532104381853NN
resource0.0416785799329393NN

Label: 8, with a score of: 0.442990745197612
WordScorePoS
addition0NN
insufficient0.0804764811724088JJ
mandate0NN
function0NN
government0NN
line0.0410992516792148NN
agency0NN
create0.0695218668857431VB
accountability0NN
lead0.0504071033101074NN
effort0NN
waste0NN
resource0.0123650647908625NN

Label: 2, with a score of: 0.35558717957965
WordScorePoS
addition0.0357189919948307NN
insufficient0JJ
mandate0.0583416713841148NN
function0.0440683498519077NN
government0NN
line0NN
agency0NN
create0VB
accountability0NN
lead0NN
effort0NN
waste0.0297950283197006NN
resource0.0358563662904843NN

Given the multisectoral nature of environmental health interventions ENVIRONMENTAL HEALTH AND CHILD SURVIVAL clear mapping of the specific roles of environmental health and infrastructural actors at each administrative level becomes even more critical

Label: 3, with a score of: 0.677437101636384
WordScorePoS
nature0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
child0.10682408961305NN
specific0JJ
actor0NN
level0NN
critical0JJ

Label: 12, with a score of: 0.523588916599714
WordScorePoS
nature0.162755901889551NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
child0NN
specific0.0542519672965169JJ
actor0.0542519672965169NN
level0.00513687014008325NN
critical0JJ

Finally in many countries funds may reside in higher levels of government than the one responsible for service delivery creating shortfalls in financing

Label: 11, with a score of: 0.443951652408526
WordScorePoS
country0NN
fund0.055245183797332NN
level0.00692515656684925NN
government0NN
responsible0JJ
service0.0269743071558856NN
create0.0315914058171786VB
financing0NN

Provide technical and policy inputs

Label: 4, with a score of: 0.528021322652655
WordScorePoS
provide0.0100202166857628VB
technical0.124876512346911JJ
policy0NN
input0NN

Label: 8, with a score of: 0.33786436868311
WordScorePoS
provide0VB
technical0.0410992516792148JJ
policy0.0452169560888236NN
input0NN

Label: 10, with a score of: 0.332009329329239
WordScorePoS
provide0VB
technical0JJ
policy0.0848203862485078NN
input0NN

Label: 2, with a score of: 0.312588053829593
WordScorePoS
provide0.0215170467912497VB
technical0JJ
policy0NN
input0.0583416713841148NN

Label: 11, with a score of: 0.30540692286366
WordScorePoS
provide0.0269743071558856VB
technical0.0373517915079663JJ
policy0.0136980135278128NN
input0NN

Agencies at the national level play an important role in providing technical and policy inputs related to environmental health actions

Label: 3, with a score of: 0.367693455480072
WordScorePoS
agency0NN
national0.00558382296134999JJ
level0NN
provide0.0100171139310145VB
technical0JJ
policy0NN
input0NN
related0.0125195145191824JJ
environmental0JJ
health0.191387734041787NN
action0NN

Label: 12, with a score of: 0.370991212318698
WordScorePoS
agency0.0542519672965169NN
national0.00743561777158133JJ
level0.00513687014008325NN
provide0.0200087191734851VB
technical0JJ
policy0.0203215381458133NN
input0NN
related0.00833571598658786JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
action0.0121782716594324NN

Label: 1, with a score of: 0.321906709479508
WordScorePoS
agency0NN
national0.0164833460638534JJ
level0.0113874611101829NN
provide0.0295703421524739VB
technical0JJ
policy0.0450489732120807NN
input0NN
related0.0184786920895884JJ
environmental0.0442083771593746JJ
health0NN
action0.0269969049497485NN

Local governments typically lack the sectoral expertise on the wide range of issues they need to address to ensure environmental health and they can benefit from technical advice and guidance from national level agencies

Label: 3, with a score of: 0.449014864117803
WordScorePoS
local0JJ
government0NN
typically0RB
lack0NN
expertise0NN
wide0.0307735781890304JJ
range0.0249430985430622NN
issue0.0249430985430622NN
ensure0.00837573444202498VB
environmental0JJ
health0.191387734041787NN
benefit0NN
technical0JJ
national0.00558382296134999JJ
level0NN
agency0NN

Label: 9, with a score of: 0.342657244794705
WordScorePoS
local0JJ
government0NN
typically0RB
lack0.0565629593551219NN
expertise0NN
wide0JJ
range0.0368585655748969NN
issue0NN
ensure0.00412562425683033VB
environmental0.0221298700466866JJ
health0.0377086395700813NN
benefit0.0260040237236563NN
technical0.030745604615229JJ
national0.00412562425683033JJ
level0NN
agency0NN

Label: 4, with a score of: 0.33385503164319
WordScorePoS
local0JJ
government0NN
typically0RB
lack0.0255262687343935NN
expertise0NN
wide0JJ
range0NN
issue0NN
ensure0.0390988676729552VB
environmental0JJ
health0NN
benefit0NN
technical0.124876512346911JJ
national0JJ
level0.0231525547935232NN
agency0NN

One set of issues relates to providing the performance standards norms guidelines training modules and technical support for environmental health services

Label: 3, with a score of: 0.433416200606356
WordScorePoS
set0NN
issue0.0249430985430622NN
provide0.0100171139310145VB
performance0NN
standard0NN
guideline0NN
training0.020806307400253NN
technical0JJ
support0.00625975725959118NN
environmental0JJ
health0.191387734041787NN
service0.0100171139310145NN

Label: 4, with a score of: 0.42739798211895
WordScorePoS
set0NN
issue0NN
provide0.0100202166857628VB
performance0NN
standard0NN
guideline0NN
training0.124876512346911NN
technical0.124876512346911JJ
support0NN
environmental0JJ
health0NN
service0NN

Label: 9, with a score of: 0.356625798804873
WordScorePoS
set0NN
issue0NN
provide0.00740117451847634VB
performance0NN
standard0.0454743001434393NN
guideline0NN
training0.030745604615229NN
technical0.030745604615229JJ
support0.0277502419802315NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
service0.0148023490369527NN

Label: 11, with a score of: 0.31334354195485
WordScorePoS
set0NN
issue0NN
provide0.0269743071558856VB
performance0NN
standard0NN
guideline0NN
training0NN
technical0.0373517915079663JJ
support0.0224752180723703NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
service0.0269743071558856NN

These require inputs primarily from the department of health but also from other departments concerned with environmental management for health such as the department of environment

Label: 3, with a score of: 0.637294641166258
WordScorePoS
require0VB
input0NN
primarily0RB
health0.191387734041787NN
environmental0JJ
management0.0127591822694525NN
environment0NN

Label: 12, with a score of: 0.46468807741261
WordScorePoS
require0.0468670845659596VB
input0NN
primarily0RB
health0.0339811641917276NN
environmental0.0598270388037045JJ
management0.0339811641917276NN
environment0.079769385071606NN

Label: 11, with a score of: 0.314481542563364
WordScorePoS
require0VB
input0NN
primarily0RB
health0.0229054731708393NN
environmental0.0537696560159885JJ
management0.0687164195125178NN
environment0.0268848280079943NN

Label: 8, with a score of: 0.31101322577871
WordScorePoS
require0.104282800328615VB
input0NN
primarily0RB
health0NN
environmental0.0295821503613099JJ
management0NN
environment0.0591643007226199NN

In addition national level health agencies can provide critical information gathered from disease surveillance assessment of health threats and research to help local governments respond appropriately to environmental health risks

Label: 3, with a score of: 0.770698591852342
WordScorePoS
addition0NN
national0.00558382296134999JJ
level0NN
health0.191387734041787NN
agency0NN
provide0.0100171139310145VB
critical0JJ
information0.00914534810831654NN
disease0.215415047323213NN
threat0NN
research0.0175975629039954NN
local0JJ
government0NN
environmental0JJ
risk0.0703902516159815NN

Label: 9, with a score of: 0.342254698525868
WordScorePoS
addition0.0368585655748969NN
national0.00412562425683033JJ
level0NN
health0.0377086395700813NN
agency0NN
provide0.00740117451847634VB
critical0.0454743001434393JJ
information0.0675706773907211NN
disease0NN
threat0NN
research0.104016094894625NN
local0JJ
government0NN
environmental0.0221298700466866JJ
risk0NN

Foster communication advocacy and promotion

Label: 5, with a score of: 0.565798858537285
WordScorePoS
foster0JJ
communication0.0465610847355851NN
promotion0.0931221694711702NN

Label: 9, with a score of: 0.557810537457951
WordScorePoS
foster0.0454743001434393JJ
communication0.0922368138456871NN
promotion0NN

Label: 17, with a score of: 0.453388957124049
WordScorePoS
foster0.036961556179878JJ
communication0.0499801157438617NN
promotion0.0249900578719309NN

Label: 4, with a score of: 0.337215263897074
WordScorePoS
foster0JJ
communication0.0416255041156371NN
promotion0.0416255041156371NN

Health ministries in developing countries have an important role to play in health promotion Cairncross and Valdmanis to raise awareness among the public as well as in advocacy to raise the profile among policy makers

Label: 3, with a score of: 0.558849475882122
WordScorePoS
health0.191387734041787NN
develop0VB
country0NN
promotion0NN
raise0NN
awareness0NN
public0.021678073222951NN
policy0NN
maker0NN

Label: 5, with a score of: 0.43421519763437
WordScorePoS
health0.0571058915334038NN
develop0VB
country0NN
promotion0.0931221694711702NN
raise0NN
awareness0NN
public0.0727679293221751NN
policy0.0341506708422088NN
maker0NN

Label: 12, with a score of: 0.423529418205194
WordScorePoS
health0.0339811641917276NN
develop0VB
country0NN
promotion0NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
public0.028867295332595NN
policy0.0203215381458133NN
maker0.0409791940864438NN

Label: 10, with a score of: 0.320496043192083
WordScorePoS
health0.0405241466500776NN
develop0VB
country0NN
promotion0NN
raise0NN
awareness0NN
public0.0172128079963482NN
policy0.0848203862485078NN
maker0.0488696285210061NN

Although nationwide campaigns on the need for immunizations polio drives for example and public health messages relating to treatment of diseases use of oral dehydration salts to treat diarrhea for example are commonplace in only few instances do national level agencies play role in promoting behavior change

Label: 3, with a score of: 0.645468160201307
WordScorePoS
polio0.0407408489778079NNP
drive0NN
public0.021678073222951NN
health0.191387734041787NN
treatment0.0624189222007589NN
disease0.215415047323213NN
national0.00558382296134999JJ
level0NN
agency0NN
promote0.00837573444202498VB
change0NN

Label: 13, with a score of: 0.592150458755358
WordScorePoS
polio0NNP
drive0.0414107553022249NN
public0NN
health0NN
treatment0NN
disease0NN
national0.0112708859309299JJ
level0.0415277415054218NN
agency0NN
promote0.00375696197697663VB
change0.402565546215053NN

Some examples of national hand washing campaigns such as Peru Lávate las manos con jabón Wash your hands with soap have met with mass popularity and success in the adoption of better hygiene

Label: 6, with a score of: 0.736373597907993
WordScorePoS
national0JJ
meet0VB
adoption0NN
hygiene0.136665345449673NN

Other examples include national hand washing campaigns in Ghana Nepal and Senegal for more information see http www

Label: 0, with a score of: 1

globalhandwashing

Label: 0, with a score of: 1

The health ministry can also play an advocacy role in raising the awareness of these issues within local and national governments

Label: 3, with a score of: 0.598514218519896
WordScorePoS
health0.191387734041787NN
raise0NN
awareness0NN
issue0.0249430985430622NN
local0JJ
national0.00558382296134999JJ
government0NN

Label: 12, with a score of: 0.461259568087902
WordScorePoS
health0.0339811641917276NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
issue0NN
local0.0144336476662975JJ
national0.00743561777158133JJ
government0NN

Label: 13, with a score of: 0.453001485842042
WordScorePoS
health0NN
raise0.0671298309154199NN
awareness0.0414107553022249NN
issue0.0335649154577099NN
local0.0145856516935579JJ
national0.0112708859309299JJ
government0NN

At ministerial meetings it could link health outcomes with infrastructure projects thus raising awareness of environmental health issues

Label: 3, with a score of: 0.564192116499978
WordScorePoS
health0.191387734041787NN
outcome0NN
infrastructure0NN
project0NN
raise0NN
awareness0NN
environmental0JJ
issue0.0249430985430622NN

Label: 9, with a score of: 0.494499036777497
WordScorePoS
health0.0377086395700813NN
outcome0.030745604615229NN
infrastructure0.192202909044225NN
project0NN
raise0.0368585655748969NN
awareness0NN
environmental0.0221298700466866JJ
issue0NN

Label: 12, with a score of: 0.468077423435144
WordScorePoS
health0.0339811641917276NN
outcome0NN
infrastructure0.028867295332595NN
project0.0664302389559493NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
environmental0.0598270388037045JJ
issue0NN

Roles of Local Governments With guidance from national level legal and regulatory frameworks accompanied by devolution of functions and funding local governments can play an important role in environmental health at the community and household levels

Label: 3, with a score of: 0.336901009629499
WordScorePoS
local0JJ
government0NN
national0.00558382296134999JJ
level0NN
legal0JJ
framework0.0108390366114755NN
function0NN
environmental0JJ
health0.191387734041787NN
community0NN
household0NN

Label: 12, with a score of: 0.391770246035068
WordScorePoS
local0.0144336476662975JJ
government0NN
national0.00743561777158133JJ
level0.00513687014008325NN
legal0JJ
framework0.028867295332595NN
function0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
community0.0169905820958638NN
household0.0554128417527413NN

Promote an integrated approach to local level health

Label: 3, with a score of: 0.592804344169067
WordScorePoS
promote0.00837573444202498VB
integrate0VB
approach0NN
local0JJ
level0NN
health0.191387734041787NN

Label: 12, with a score of: 0.423221096402156
WordScorePoS
promote0.0148712355431627VB
integrate0.0199423462679015VB
approach0.0542519672965169NN
local0.0144336476662975JJ
level0.00513687014008325NN
health0.0339811641917276NN

Label: 11, with a score of: 0.305829872797129
WordScorePoS
promote0VB
integrate0.0537696560159885VB
approach0NN
local0.0194583992186006JJ
level0.00692515656684925NN
health0.0229054731708393NN

Given the nature of environmental risks and transmission mechanisms the most appropriate levels for carrying out actions are the household and community levels

Label: 12, with a score of: 0.603112262439655
WordScorePoS
nature0.162755901889551NN
environmental0.0598270388037045JJ
risk0NN
mechanism0NN
level0.00513687014008325NN
action0.0121782716594324NN
household0.0554128417527413NN
community0.0169905820958638NN

Label: 17, with a score of: 0.354584871709228
WordScorePoS
nature0NN
environmental0JJ
risk0NN
mechanism0.147846224719512NN
level0.0138997399903163NN
action0.0109843026967392NN
household0NN
community0NN

Label: 13, with a score of: 0.371864456810256
WordScorePoS
nature0NN
environmental0JJ
risk0NN
mechanism0.0414107553022249NN
level0.0415277415054218NN
action0.0369195714265843NN
household0NN
community0.0343390275626203NN

Local governments APPROACHES TO ENVIRONMENTAL HEALTH are therefore best placed to ensure the intersectoral and interjurisdictional coordination needed to ensure public health because they are the convergent point at the appropriate level of all the departments whose actions affect environmental health

Label: 3, with a score of: 0.62564975275135
WordScorePoS
local0JJ
government0NN
approach0NN
environmental0JJ
health0.191387734041787NN
ensure0.00837573444202498VB
coordination0NN
public0.021678073222951NN
level0NN
action0NN
affect0.00625975725959118VB

Label: 12, with a score of: 0.37205035927768
WordScorePoS
local0.0144336476662975JJ
government0NN
approach0.0542519672965169NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
ensure0.00743561777158133VB
coordination0NN
public0.028867295332595NN
level0.00513687014008325NN
action0.0121782716594324NN
affect0.0166714319731757VB

Label: 5, with a score of: 0.330868356464536
WordScorePoS
local0JJ
government0NN
approach0NN
environmental0JJ
health0.0571058915334038NN
ensure0.0124956749436837VB
coordination0NN
public0.0727679293221751NN
level0.0172651853471334NN
action0.0409315617631NN
affect0VB

The benefits of intersectoral coordination at the local level are illustrated by successful malaria control program in Kheda district in Gujarat India

Label: 3, with a score of: 0.645139334792508
WordScorePoS
benefit0NN
coordination0NN
local0JJ
level0NN
successful0JJ
malaria0.20370424488904NN
control0.020806307400253NN

Label: 17, with a score of: 0.499183523403922
WordScorePoS
benefit0NN
coordination0.0978661089756501NN
local0.0130185595639838JJ
level0.0138997399903163NN
successful0.048933054487825JJ
malaria0NN
control0NN

Conducted with the active participation of local communities it involved intensified case detection and treatment to reduce the number of mosquitoes carrying malaria parasites coupled with eliminating vector breeding habitats in homes and in irrigation canals and the use of larvivorous fish

Label: 3, with a score of: 0.479433627901869
WordScorePoS
conduct0NN
active0JJ
participation0NN
local0JJ
community0NN
involve0VB
treatment0.0624189222007589NN
reduce0.01675146888405VB
malaria0.20370424488904NN
eliminate0VB
breed0NN
habitat0NN
home0NN
irrigation0NN
fish0NN

Label: 10, with a score of: 0.430152416111521
WordScorePoS
conduct0.064698038783335NN
active0JJ
participation0NN
local0JJ
community0.0202620733250388NN
involve0.0488696285210061VB
treatment0.0330412182586772NN
reduce0.0310356414389692VB
malaria0NN
eliminate0.0558912165956601VB
breed0NN
habitat0NN
home0NN
irrigation0NN
fish0NN

The active participation of the district and local governments and the high level of intersectoral coordination including those responsible for the health fisheries and irrigation sectors contributed to the success of this effort in reducing the number of mosquito breeding places Malaviya and others

Label: 14, with a score of: 0.522293453416351
WordScorePoS
active0JJ
participation0NN
local0JJ
government0NN
level0.010074208709011NN
coordination0NN
include0VB
responsible0JJ
health0.0166605993001162NN
fishery0.227990221432093NN
irrigation0NN
sector0NN
contribute0.0815049608642826VB
effort0.0166605993001162NN
reduce0.0036456034155327VB
breed0NN

Label: 3, with a score of: 0.323596265164862
WordScorePoS
active0JJ
participation0NN
local0JJ
government0NN
level0NN
coordination0NN
include0VB
responsible0JJ
health0.191387734041787NN
fishery0NN
irrigation0NN
sector0NN
contribute0VB
effort0.0127591822694525NN
reduce0.01675146888405VB
breed0NN

Label: 17, with a score of: 0.435031871860126
WordScorePoS
active0.048933054487825JJ
participation0NN
local0.0130185595639838JJ
government0.048933054487825NN
level0.0138997399903163NN
coordination0.0978661089756501NN
include0VB
responsible0JJ
health0NN
fishery0NN
irrigation0NN
sector0.0459744293658165NN
contribute0.0249900578719309VB
effort0NN
reduce0.00335331148065841VB
breed0NN

Provide civic amenities related to environmental health

Label: 3, with a score of: 0.654710149303359
WordScorePoS
provide0.0100171139310145VB
related0.0125195145191824JJ
environmental0JJ
health0.191387734041787NN

Label: 12, with a score of: 0.373845087268107
WordScorePoS
provide0.0200087191734851VB
related0.00833571598658786JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN

Label: 11, with a score of: 0.351608922690415
WordScorePoS
provide0.0269743071558856VB
related0.0112376090361851JJ
environmental0.0537696560159885JJ
health0.0229054731708393NN

A core task of any local government is to provide basic civic amenities and local governments have at their disposal range of funds and other resources that they can use for these tasks including locally generated revenues

Label: 17, with a score of: 0.532559733638146
WordScorePoS
local0.0130185595639838JJ
government0.048933054487825NN
provide0.00601568197638796VB
basic0JJ
range0NN
fund0NN
resource0.0375923735942499NN
include0VB
generate0VB
revenue0.0978661089756501NN

Label: 11, with a score of: 0.450450510621243
WordScorePoS
local0.0194583992186006JJ
government0NN
provide0.0269743071558856VB
basic0.0583751976558017JJ
range0NN
fund0.055245183797332NN
resource0.0449504361447405NN
include0VB
generate0VB
revenue0NN

These basic amenities include the construction maintenance and cleaning of public resources such as roads drains water supply systems sewers and waste disposal sites measures to improve the sanitary condition of the locality such as solid waste removal and monitoring activities such as the protection of water sources

Label: 6, with a score of: 0.748688867197033
WordScorePoS
basic0.0181797964452808JJ
include0VB
public0NN
resource0.0104991907358033NN
road0NN
water0.556409482163189NN
supply0.0590310971343993NN
system0NN
waste0NN
measure0NN
improve0.0511916925627245VB
condition0NN
removal0.0683326727248364NN
monitor0NN
activity0.0502364757923669NN
protection0NN
source0.0613562156822703NN

Label: 12, with a score of: 0.470804193352785
WordScorePoS
basic0.0144336476662975JJ
include0VB
public0.028867295332595NN
resource0.0416785799329393NN
road0NN
water0.186896403054502NN
supply0.0703006268489394NN
system0NN
waste0.138532104381853NN
measure0NN
improve0VB
condition0.0409791940864438NN
removal0NN
monitor0.0332151194779746NN
activity0.0199423462679015NN
protection0NN
source0NN

Mobilize citizens and support health activities

Label: 3, with a score of: 0.640035353155596
WordScorePoS
mobilize0VB
support0.00625975725959118NN
health0.191387734041787NN
activity0NN

Label: 17, with a score of: 0.437123575214738
WordScorePoS
mobilize0.0898760357768464VB
support0.0451108483130998NN
health0NN
activity0NN

With their strong grassroots presence local governments can do great deal to enhance the effectiveness of services and programs aimed at improving health

Label: 3, with a score of: 0.531319100507109
WordScorePoS
strong0JJ
local0JJ
government0NN
enhance0VB
service0.0100171139310145NN
aim0.020806307400253NN
improve0VB
health0.191387734041787NN

Label: 17, with a score of: 0.395525132037253
WordScorePoS
strong0JJ
local0.0130185595639838JJ
government0.048933054487825NN
enhance0.0601477977507998VB
service0NN
aim0.0249900578719309NN
improve0.0183291958415182VB
health0NN

For example they can help collect disease surveillance information by reporting easily identifiable conditions such as an episode of severe vomiting and diarrhea

Label: 3, with a score of: 0.765105784561301
WordScorePoS
disease0.215415047323213NN
information0.00914534810831654NN
report0.0307735781890304NN
condition0NN

Label: 8, with a score of: 0.364300508655722
WordScorePoS
disease0NN
information0NN
report0NN
condition0.121575732851624NN

They can disseminate public health messages and mobilize citizens to improve their own health behaviors and environmental hygiene and to pressure others around them to help maintain better sanitary conditions in their neighborhoods

Label: 3, with a score of: 0.585978328440489
WordScorePoS
public0.021678073222951NN
health0.191387734041787NN
mobilize0VB
improve0VB
environmental0JJ
hygiene0NN
pressure0NN
maintain0VB
condition0NN

Label: 6, with a score of: 0.27217008105477
WordScorePoS
public0NN
health0NN
mobilize0VB
improve0.0511916925627245VB
environmental0JJ
hygiene0.136665345449673NN
pressure0NN
maintain0VB
condition0NN

Label: 11, with a score of: 0.428620588043886
WordScorePoS
public0.0583751976558017NN
health0.0229054731708393NN
mobilize0VB
improve0.0273960270556257VB
environmental0.0537696560159885JJ
hygiene0NN
pressure0.055245183797332NN
maintain0.055245183797332VB
condition0NN

Additionally local governments can mobilize community based groups to help improve environmental services

Label: 17, with a score of: 0.482891601774592
WordScorePoS
additionally0RB
local0.0130185595639838JJ
government0.048933054487825NN
mobilize0.0898760357768464VB
community0NN
base0.017987180284335NN
improve0.0183291958415182VB
environmental0JJ
service0NN

Label: 15, with a score of: 0.356279157721508
WordScorePoS
additionally0RB
local0.0275274877486226JJ
government0NN
mobilize0.0633470357346975VB
community0.016202004209163NN
base0.0190167691930804NN
improve0VB
environmental0JJ
service0.0127200410376242NN

Label: 1, with a score of: 0.340774109738355
WordScorePoS
additionally0RB
local0JJ
government0NN
mobilize0VB
community0NN
base0.0442083771593746NN
improve0VB
environmental0.0442083771593746JJ
service0.0443555132287109NN

Label: 11, with a score of: 0.327494802723015
WordScorePoS
additionally0RB
local0.0194583992186006JJ
government0NN
mobilize0VB
community0NN
base0NN
improve0.0273960270556257VB
environmental0.0537696560159885JJ
service0.0269743071558856NN

Label: 12, with a score of: 0.302508375179523
WordScorePoS
additionally0RB
local0.0144336476662975JJ
government0NN
mobilize0VB
community0.0169905820958638NN
base0.0199423462679015NN
improve0VB
environmental0.0598270388037045JJ
service0.00666957305782837NN

The total sanitation program in West Bengal illustrates how successful local governments can be in inducing widespread adoption of personal latrines and in using NGOs to set up for profit sanitary marts where latrines are produced to given standards and retailed for an agreed price Majumder also see discussion in Mavalankar and Manjunath

Label: 6, with a score of: 0.739107174819443
WordScorePoS
total0.0295155485671997NN
sanitation0.334686906581616NN
successful0JJ
local0.0181797964452808JJ
government0NN
adoption0NN
personal0JJ
latrine0.0683326727248364NN
set0NN
produce0VB
standard0NN
retail0JJ
agree0VB
price0NN

Under the leadership of local governments citizens groups such as self help groups are active in the rural areas of West Bengal and have proved to be powerful force in the spread of pit latrines

Label: 2, with a score of: 0.627853692150701
WordScorePoS
leadership0NN
local0.0155217067874935JJ
government0NN
active0JJ
rural0.148975141598503JJ
force0.0297950283197006NN
spread0NN
latrine0NN

Label: 17, with a score of: 0.477764689057459
WordScorePoS
leadership0.036961556179878NN
local0.0130185595639838JJ
government0.048933054487825NN
active0.048933054487825JJ
rural0JJ
force0NN
spread0NN
latrine0NN

These successful efforts to mobilize citizens can be extended to larger range of environmental health issues such as solid waste management vector control and drainage

Label: 3, with a score of: 0.494096185017452
WordScorePoS
successful0JJ
effort0.0127591822694525NN
mobilize0VB
extend0VB
range0.0249430985430622NN
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
waste0NN
management0.0127591822694525NN
control0.020806307400253NN

Label: 12, with a score of: 0.457541941049679
WordScorePoS
successful0JJ
effort0NN
mobilize0VB
extend0VB
range0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
issue0NN
waste0.138532104381853NN
management0.0339811641917276NN
control0NN

Label: 11, with a score of: 0.353305937719783
WordScorePoS
successful0JJ
effort0.0229054731708393NN
mobilize0VB
extend0VB
range0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
issue0NN
waste0.0373517915079663NN
management0.0687164195125178NN
control0NN

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Strengthen roles in communication and advocacy

Label: 3, with a score of: 0.66360058532957
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
strengthen0.0150256708965218VB
communication0NN

Label: 9, with a score of: 0.322174948463337
WordScorePoS
environmental0.0221298700466866JJ
health0.0377086395700813NN
child0NN
strengthen0VB
communication0.0922368138456871NN

A critical component of environmental health programs is to raise citizen awareness of the benefits of clean water proper sanitation and good hygiene behavior as well as to stimulate their demand for these services

Label: 6, with a score of: 0.828860905382271
WordScorePoS
critical0JJ
environmental0JJ
health0NN
raise0NN
awareness0NN
benefit0NN
clean0.0348974218717993JJ
water0.556409482163189NN
proper0JJ
sanitation0.334686906581616NN
hygiene0.136665345449673NN
stimulate0VB
demand0NN
service0.0084006124696649NN

Label: 12, with a score of: 0.31151953411748
WordScorePoS
critical0JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
benefit0NN
clean0JJ
water0.186896403054502NN
proper0JJ
sanitation0NN
hygiene0NN
stimulate0VB
demand0NN
service0.00666957305782837NN

Label: 3, with a score of: 0.236988451083155
WordScorePoS
critical0JJ
environmental0JJ
health0.191387734041787NN
raise0NN
awareness0NN
benefit0NN
clean0.020806307400253JJ
water0.0382775468083574NN
proper0JJ
sanitation0.0249430985430622NN
hygiene0NN
stimulate0VB
demand0.020806307400253NN
service0.0100171139310145NN

Label: 7, with a score of: 0.131696576604481
WordScorePoS
critical0JJ
environmental0JJ
health0NN
raise0NN
awareness0NN
benefit0NN
clean0.125032076213024JJ
water0NN
proper0JJ
sanitation0NN
hygiene0NN
stimulate0VB
demand0NN
service0.0451471467893167NN

Although national level campaigns play an important role in raising awareness more community specific and customized messages relating to behavior change for better environmental health should be advocated by local health units and schools

Label: 13, with a score of: 0.645708562047462
WordScorePoS
national0.0112708859309299JJ
level0.0415277415054218NN
raise0.0671298309154199NN
awareness0.0414107553022249NN
community0.0343390275626203NN
specific0JJ
change0.402565546215053NN
environmental0JJ
health0NN
local0.0145856516935579JJ
school0NN

Label: 3, with a score of: 0.409195288882242
WordScorePoS
national0.00558382296134999JJ
level0NN
raise0NN
awareness0NN
community0NN
specific0JJ
change0NN
environmental0JJ
health0.191387734041787NN
local0JJ
school0NN

Label: 4, with a score of: 0.243688562206911
WordScorePoS
national0JJ
level0.0231525547935232NN
raise0NN
awareness0NN
community0NN
specific0JJ
change0NN
environmental0JJ
health0NN
local0JJ
school0.208127520578185NN

Label: 12, with a score of: 0.359518018508261
WordScorePoS
national0.00743561777158133JJ
level0.00513687014008325NN
raise0.0332151194779746NN
awareness0.0819583881728876NN
community0.0169905820958638NN
specific0.0542519672965169JJ
change0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
local0.0144336476662975JJ
school0NN

Local governments can reach citizens more effectively by engaging communities and individuals in host of face to face forms of communication

Label: 16, with a score of: 0.538671989729305
WordScorePoS
local0JJ
government0NN
reach0.0658099748168827NN
effectively0RB
engage0VB
community0NN
individual0JJ
form0.158049144643351NN
communication0NN

Label: 9, with a score of: 0.376743256818465
WordScorePoS
local0JJ
government0NN
reach0NN
effectively0RB
engage0.0454743001434393VB
community0.0188543197850406NN
individual0JJ
form0NN
communication0.0922368138456871NN

Label: 5, with a score of: 0.353969920682636
WordScorePoS
local0JJ
government0NN
reach0NN
effectively0RB
engage0VB
community0NN
individual0JJ
form0.100540298425703NN
communication0.0465610847355851NN

Label: 12, with a score of: 0.352757998389766
WordScorePoS
local0.0144336476662975JJ
government0NN
reach0.0332151194779746NN
effectively0RB
engage0.0819583881728876VB
community0.0169905820958638NN
individual0JJ
form0NN
communication0NN

Reorient the role of an environmental health workforce

Label: 3, with a score of: 0.759203411930338
WordScorePoS
environmental0JJ
health0.191387734041787NN
workforce0.0307735781890304NN

Label: 9, with a score of: 0.359890944499152
WordScorePoS
environmental0.0221298700466866JJ
health0.0377086395700813NN
workforce0.0454743001434393NN

Label: 12, with a score of: 0.320575653186597
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
workforce0NN

Whether under the aegis of the health department or the local governments minimum complement of public health personnel is needed at each administrative level to implement and ensure good environmental health

Label: 3, with a score of: 0.703319521636852
WordScorePoS
health0.191387734041787NN
local0JJ
government0NN
complement0NN
public0.021678073222951NN
level0NN
implement0VB
ensure0.00837573444202498VB
environmental0JJ

Label: 17, with a score of: 0.304913886590137
WordScorePoS
health0NN
local0.0130185595639838JJ
government0.048933054487825NN
complement0.0978661089756501NN
public0.0390556786919513NN
level0.0138997399903163NN
implement0.0458229896037954VB
ensure0.00335331148065841VB
environmental0JJ

Unlike century ago the all encompassing role of the environmental health officer may no longer be realistic

Label: 13, with a score of: 0.650971322104789
WordScorePoS
century0.219293228426234NN
environmental0JJ
health0NN

Label: 3, with a score of: 0.568133941745178
WordScorePoS
century0NN
environmental0JJ
health0.191387734041787NN

The role will have to be reoriented through in service training at the local level to address the changing priorities in environmental health

Label: 13, with a score of: 0.690180856939234
WordScorePoS
service0NN
training0NN
local0.0145856516935579JJ
level0.0415277415054218NN
change0.402565546215053NN
priority0NN
environmental0JJ
health0NN

Label: 3, with a score of: 0.334364350438149
WordScorePoS
service0.0100171139310145NN
training0.020806307400253NN
local0JJ
level0NN
change0NN
priority0NN
environmental0JJ
health0.191387734041787NN

In South Africa for example environmental health officers form the backbone of environmental health services and are employed at the local and state levels

Label: 3, with a score of: 0.547394430869261
WordScorePoS
south0RB
africa0IN
environmental0JJ
health0.191387734041787NN
form0NN
service0.0100171139310145NN
employ0VB
local0JJ
level0NN

Label: 16, with a score of: 0.305359362556305
WordScorePoS
south0RB
africa0IN
environmental0JJ
health0NN
form0.158049144643351NN
service0NN
employ0VB
local0JJ
level0.0610668815653026NN

Label: 5, with a score of: 0.35457825566755
WordScorePoS
south0RB
africa0IN
environmental0JJ
health0.0571058915334038NN
form0.100540298425703NN
service0.022416649027415NN
employ0VB
local0JJ
level0.0172651853471334NN

Label: 1, with a score of: 0.324117810167066
WordScorePoS
south0RB
africa0IN
environmental0.0442083771593746JJ
health0NN
form0.0884167543187491NN
service0.0443555132287109NN
employ0VB
local0JJ
level0.0113874611101829NN

Because of the need for multiple skills in response to the crosscutting nature of environmental health interventions training of environmental health officers has changed fundamentally with the focus moving beyond law enforcement to community participation and development Mathee Swanepoel and Swart Thomas Seager and Mathee

Label: 13, with a score of: 0.477713217375899
WordScorePoS
multiple0JJ
skill0NN
response0.0548233071065585NN
nature0NN
environmental0JJ
health0NN
intervention0NN
training0NN
change0.402565546215053NN
focus0.0279982034978914NN
move0.0414107553022249NN
law0NN
community0.0343390275626203NN
participation0NN
development0NN

Label: 4, with a score of: 0.477033955618495
WordScorePoS
multiple0JJ
skill0.407534682675042NN
response0NN
nature0NN
environmental0JJ
health0NN
intervention0NN
training0.124876512346911NN
change0NN
focus0NN
move0NN
law0NN
community0NN
participation0NN
development0.0279277626235394NN

Label: 3, with a score of: 0.385396171198291
WordScorePoS
multiple0JJ
skill0NN
response0NN
nature0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
training0.020806307400253NN
change0NN
focus0NN
move0NN
law0NN
community0NN
participation0NN
development0.00837573444202498NN

Label: 12, with a score of: 0.366624813922086
WordScorePoS
multiple0JJ
skill0NN
response0NN
nature0.162755901889551NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
training0NN
change0NN
focus0NN
move0.0409791940864438NN
law0NN
community0.0169905820958638NN
participation0NN
development0.022306853314744NN

Label: 16, with a score of: 0.218292133207741
WordScorePoS
multiple0JJ
skill0NN
response0NN
nature0NN
environmental0JJ
health0NN
intervention0NN
training0NN
change0NN
focus0NN
move0NN
law0.164686343640793NN
community0NN
participation0.0548954478802642NN
development0.0368309542451156NN

Establish and enforce regulations

Label: 16, with a score of: 0.636886934627598
WordScorePoS
establish0VB
enforce0.107490825192354VB
regulation0NN

Label: 10, with a score of: 0.579108549021484
WordScorePoS
establish0VB
enforce0VB
regulation0.0977392570420122NN

Label: 17, with a score of: 0.50892860103446
WordScorePoS
establish0.048933054487825VB
enforce0VB
regulation0.036961556179878NN

Local government can play an important role in establishing monitoring and enforcing regulation

Label: 17, with a score of: 0.742797933941849
WordScorePoS
local0.0130185595639838JJ
government0.048933054487825NN
establish0.048933054487825VB
monitor0.0599173571845643NN
enforce0VB
regulation0.036961556179878NN

Label: 10, with a score of: 0.491054258122268
WordScorePoS
local0JJ
government0NN
establish0VB
monitor0.0396106020715138NN
enforce0VB
regulation0.0977392570420122NN

Label: 16, with a score of: 0.384302013561976
WordScorePoS
local0JJ
government0NN
establish0VB
monitor0NN
enforce0.107490825192354VB
regulation0NN

This activity involves building codes land tenure bylaws and tenancy regulation

Label: 17, with a score of: 0.515312445633717
WordScorePoS
activity0NN
involve0VB
building0.149940347231585NN
land0NN
regulation0.036961556179878NN

Label: 10, with a score of: 0.40421944341996
WordScorePoS
activity0NN
involve0.0488696285210061VB
building0NN
land0NN
regulation0.0977392570420122NN

Label: 15, with a score of: 0.393967279891003
WordScorePoS
activity0.0190167691930804NN
involve0VB
building0NN
land0.123873694868802NN
regulation0NN

Label: 12, with a score of: 0.320748766388504
WordScorePoS
activity0.0199423462679015NN
involve0.0819583881728876VB
building0NN
land0.0144336476662975NN
regulation0NN

Label: 11, with a score of: 0.31326591956398
WordScorePoS
activity0NN
involve0VB
building0.0747035830159326NN
land0.0389167984372011NN
regulation0NN

Label: 16, with a score of: 0.302707537858089
WordScorePoS
activity0NN
involve0VB
building0.109790895760528NN
land0NN
regulation0NN

Regulations can require that no house be occupied without prior construction of latrine can prevent landlords from raising rent if the tenant has latrine built and can even show the mason how to build it

Label: 0, with a score of: 1

Local government is usually responsible for outbreak investigation and the ensuing environmental health measures with the cooperation and technical knowledge of experts in the national governments

Label: 3, with a score of: 0.376138240912401
WordScorePoS
local0JJ
government0NN
responsible0JJ
environmental0JJ
health0.191387734041787NN
measure0NN
cooperation0NN
technical0JJ
knowledge0NN
national0.00558382296134999JJ

Label: 1, with a score of: 0.357309590006379
WordScorePoS
local0JJ
government0NN
responsible0JJ
environmental0.0442083771593746JJ
health0NN
measure0.103895385378356NN
cooperation0.0225244866060403NN
technical0JJ
knowledge0NN
national0.0164833460638534JJ

Label: 4, with a score of: 0.34710413977877
WordScorePoS
local0JJ
government0NN
responsible0JJ
environmental0JJ
health0NN
measure0NN
cooperation0.0152653111258778NN
technical0.124876512346911JJ
knowledge0.0416255041156371NN
national0JJ

Environmental health regulations are necessary but not sufficient because many environmental health issues are the result of informal settlements or slums where regulations are not enforced

Label: 11, with a score of: 0.583045060513456
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
regulation0NN
sufficient0JJ
issue0NN
result0NN
settlement0.146277152173395NN
slum0.146277152173395NN
enforce0VB

Label: 3, with a score of: 0.533114742986653
WordScorePoS
environmental0JJ
health0.191387734041787NN
regulation0NN
sufficient0JJ
issue0.0249430985430622NN
result0NN
settlement0NN
slum0NN
enforce0VB

Label: 10, with a score of: 0.423767289836918
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
regulation0.0977392570420122NN
sufficient0JJ
issue0NN
result0NN
settlement0NN
slum0NN
enforce0VB

The roles and responsibilities at the local and national levels discussed here are generic and broadly represent the key institutional requirements for better environmental health governance

Label: 3, with a score of: 0.425810746772434
WordScorePoS
responsibility0NN
local0JJ
national0.00558382296134999JJ
level0NN
represent0VB
key0NN
institutional0JJ
environmental0JJ
health0.191387734041787NN
governance0NN

Label: 16, with a score of: 0.428082598202475
WordScorePoS
responsibility0NN
local0JJ
national0.0294647633960925JJ
level0.0610668815653026NN
represent0VB
key0NN
institutional0JJ
environmental0JJ
health0NN
governance0.107490825192354NN

Label: 5, with a score of: 0.384880525487761
WordScorePoS
responsibility0.0911713013253052NN
local0JJ
national0.0124956749436837JJ
level0.0172651853471334NN
represent0VB
key0NN
institutional0JJ
environmental0JJ
health0.0571058915334038NN
governance0NN

Label: 13, with a score of: 0.324713072635721
WordScorePoS
responsibility0NN
local0.0145856516935579JJ
national0.0112708859309299JJ
level0.0415277415054218NN
represent0VB
key0NN
institutional0.0828215106044499JJ
environmental0JJ
health0NN
governance0NN

An important next step would be to carry out an in depth institutional analysis at country level to better understand the coordination mechanisms between ministries and how mandates and budgets are assigned

Label: 17, with a score of: 0.840506604083005
WordScorePoS
institutional0.036961556179878JJ
country0NN
level0.0138997399903163NN
coordination0.0978661089756501NN
mechanism0.147846224719512NN
mandate0NN

Label: 13, with a score of: 0.469773327405971
WordScorePoS
institutional0.0828215106044499JJ
country0NN
level0.0415277415054218NN
coordination0NN
mechanism0.0414107553022249NN
mandate0NN

Such an understanding is critical for environmental health an issue that is inherently multisectoral requiring collaborations across health environment APPROACHES TO ENVIRONMENTAL HEALTH and infrastructure ministries

Label: 3, with a score of: 0.617504771514666
WordScorePoS
critical0JJ
environmental0JJ
health0.191387734041787NN
issue0.0249430985430622NN
require0VB
environment0NN
approach0NN
infrastructure0NN

Label: 9, with a score of: 0.456807272436145
WordScorePoS
critical0.0454743001434393JJ
environmental0.0221298700466866JJ
health0.0377086395700813NN
issue0NN
require0.0260040237236563VB
environment0.0221298700466866NN
approach0NN
infrastructure0.192202909044225NN

Label: 12, with a score of: 0.444600102141893
WordScorePoS
critical0JJ
environmental0.0598270388037045JJ
health0.0339811641917276NN
issue0NN
require0.0468670845659596VB
environment0.079769385071606NN
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For specific country this type of analysis would help governments better define the roles and responsibilities of different agencies correct the incentive structures and improve the implementation of environmental health programs and actions

Label: 3, with a score of: 0.396555357567369
WordScorePoS
specific0JJ
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Label: 5, with a score of: 0.495925745101032
WordScorePoS
specific0JJ
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Label: 12, with a score of: 0.450494091010796
WordScorePoS
specific0.0542519672965169JJ
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Label: 17, with a score of: 0.349984124817384
WordScorePoS
specific0JJ
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Critical Moment critical moment has arrived for this neglected story to take the forefront

Label: 0, with a score of: 1

As this chapter shows governments in several developing countries are beginning to incorporate environmental health actions in their sectoral strategies

Label: 3, with a score of: 0.623191069627195
WordScorePoS
government0NN
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Label: 1, with a score of: 0.348534213807569
WordScorePoS
government0NN
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Label: 12, with a score of: 0.320065344537186
WordScorePoS
government0NN
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Similar changes are occurring in the donor community with growing recognition of the crucial role of environmental health

Label: 3, with a score of: 0.58107199391195
WordScorePoS
occur0.0307735781890304VB
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Label: 12, with a score of: 0.485860633164279
WordScorePoS
occur0.0409791940864438VB
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Label: 9, with a score of: 0.412601952573952
WordScorePoS
occur0VB
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Label: 10, with a score of: 0.327184700266317
WordScorePoS
occur0VB
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Multilateral development banks such as the World Bank acknowledging the need for multisectoral collaborations to improve health outcomes are revisiting the role of the health sector while acknowledging the multisectoral nature of such outcomes

Label: 3, with a score of: 0.506374654431633
WordScorePoS
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Label: 12, with a score of: 0.354776250978581
WordScorePoS
multilateral0JJ
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Label: 17, with a score of: 0.307804014268762
WordScorePoS
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The Bank newly released Health Sector Strategy states One of the clearest cases for strong government intervention in the [health nutrition and population] sector can be made when there are large externalities the benefits to society are greater than the sum of benefits to individuals

Label: 2, with a score of: 0.497452971980712
WordScorePoS
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Label: 3, with a score of: 0.351103149648097
WordScorePoS
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This is true in the case of clean water sanitation services vector control food safety measures

Label: 6, with a score of: 0.818743580093818
WordScorePoS
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Label: 12, with a score of: 0.32590796098815
WordScorePoS
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Label: 2, with a score of: 0.305884422840545
WordScorePoS
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Label: 7, with a score of: 0.178617214135958
WordScorePoS
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World Bank Additionally other international organizations such as WHO are strengthening measures to evaluate the disease burden from environmental risks in developing countries

Label: 3, with a score of: 0.589658257323532
WordScorePoS
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Label: 2, with a score of: 0.429576844351014
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Label: 1, with a score of: 0.384003097781585
WordScorePoS
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Recognizing the effect of environmental health on malnutrition new WHO burden of disease estimates are now including the consequences of malnutrition that are due to poor sanitation in developing countries Fewtrell and others

Label: 6, with a score of: 0.649276534138033
WordScorePoS
recognize0VB
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Label: 3, with a score of: 0.495046412520382
WordScorePoS
recognize0VB
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Label: 1, with a score of: 0.396801777409564
WordScorePoS
recognize0VB
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The Pan American Health Organization stresses that multisectoral community health approach is vital to reduce many of the neglected diseases in Latin America which are often preventable through improved environmental health Holveck and others

Label: 3, with a score of: 0.84092700138422
WordScorePoS
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UNICEF with its focus on child survival and development has been consistent in its approach emphasizing water and sanitation measures alongside nutritional and health system strategies

Label: 6, with a score of: 0.77671167492273
WordScorePoS
focus0NN
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Label: 3, with a score of: 0.32602681460516
WordScorePoS
focus0NN
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Label: 12, with a score of: 0.25201731417433
WordScorePoS
focus0NN
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Key Messages â–  Lessons from history have shown the enormous benefits of multisectoral environmental health actions

Label: 3, with a score of: 0.517883150965514
WordScorePoS
key0NN
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Label: 5, with a score of: 0.371844172042568
WordScorePoS
key0NN
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Label: 15, with a score of: 0.326766072761602
WordScorePoS
key0.0528409850971592NN
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Today developed countries have undergone an evolution in environmental health functions

Label: 3, with a score of: 0.678654707517912
WordScorePoS
develop0VB
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Label: 9, with a score of: 0.425663290646065
WordScorePoS
develop0VB
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Label: 12, with a score of: 0.332640850185027
WordScorePoS
develop0VB
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Both institutionally and conceptually however environmental health has fallen through the cracks in the development agenda in the world poorest countries

Label: 3, with a score of: 0.712755731552702
WordScorePoS
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL â–  â–  â–  Several governments in developing countries are beginning to mainstream environmental health components and objectives within existing child survival programs nutrition initiatives and infrastructure projects water and sanitation rural energy

Label: 6, with a score of: 0.563417126719974
WordScorePoS
environmental0JJ
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Label: 7, with a score of: 0.402593031813624
WordScorePoS
environmental0JJ
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Label: 3, with a score of: 0.365211539703158
WordScorePoS
environmental0JJ
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Label: 12, with a score of: 0.352667043665689
WordScorePoS
environmental0.0598270388037045JJ
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Label: 9, with a score of: 0.284697941865332
WordScorePoS
environmental0.0221298700466866JJ
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Label: 2, with a score of: 0.255722491606469
WordScorePoS
environmental0JJ
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Some common elements for successful environmental health actions in developing countries have included obtaining high level political commitment involving and empowering communities allocating responsibilities and resources at the local level and finding balance between private and public sector roles

Label: 3, with a score of: 0.26265425738504
WordScorePoS
common0.0615471563780609JJ
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Label: 5, with a score of: 0.578561678641568
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common0JJ
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Label: 17, with a score of: 0.370297308410041
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common0JJ
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Label: 12, with a score of: 0.30336692714196
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common0JJ
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Furthermore successful environmental health governance requires strong institutional underpinnings with clearly articulated roles at all levels of administration within country

Label: 3, with a score of: 0.430721884932383
WordScorePoS
successful0JJ
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Label: 13, with a score of: 0.386436540166177
WordScorePoS
successful0JJ
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Label: 16, with a score of: 0.379342456495598
WordScorePoS
successful0JJ
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Label: 12, with a score of: 0.328153147983478
WordScorePoS
successful0JJ
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Label: 8, with a score of: 0.318414568529071
WordScorePoS
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Now is critical moment for this agenda to take the forefront in developing countries with governments donors and civil society beginning to strengthen measures to address environmental health especially in the context of child survival

Label: 3, with a score of: 0.45181774450303
WordScorePoS
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Label: 17, with a score of: 0.494244321278679
WordScorePoS
critical0.036961556179878JJ
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Label: 16, with a score of: 0.43239086306338
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Note The framework provided in this section is based on Das Gupta and others analysis of environmental sanitation and public health in India and was adapted to discuss the broader issue of environmental health

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WordScorePoS
framework0.0108390366114755NN
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Label: 6, with a score of: 0.421546744904588
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H P E Conclusion THE CHILD HEALTH AGENDA REMAINS UNFINISHED in the developing world with millions of children continuing to fall sick and die from preventable environmental health causes

Label: 3, with a score of: 0.796485552272541
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Malnutrition poor environmental conditions and infectious diseases are highly associated geographically and take their heaviest tolls on children under five years of age in South Asia Sub Saharan Africa and certain countries in the Eastern Mediterranean region Fewtrell and others

Label: 1, with a score of: 0.647480788545618
WordScorePoS
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Label: 3, with a score of: 0.600104525164676
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The contribution of repeated infections especially diarrheal episodes to child nutritional status and subsequent mortality has only recently been incorporated in assessments of the environmental burden of disease Fewtrell and others

Label: 3, with a score of: 0.90562557886874
WordScorePoS
contribution0NN
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A recent collective expert opinion stated that about percent of the consequences of malnutrition are in fact caused by inadequate water and sanitation provisions and poor hygienic practices Prüss Üstün and Corvalán

Label: 6, with a score of: 0.905674757813124
WordScorePoS
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sanitation0.334686906581616NN
provision0NN
poor0.0642010940957526JJ
practice0NN

Label: 1, with a score of: 0.249648211793016
WordScorePoS
malnutrition0.0736315832425121NN
cause0NN
inadequate0.0736315832425121JJ
water0NN
sanitation0NN
provision0NN
poor0.150659516460257JJ
practice0NN

Label: 12, with a score of: 0.243996579079982
WordScorePoS
malnutrition0NN
cause0NN
inadequate0JJ
water0.186896403054502NN
sanitation0NN
provision0NN
poor0.0339811641917276JJ
practice0.0703006268489394NN

Evidence from review of recent cohort studies undertaken for this report further corroborates this link between environmental infections and malnutrition

Label: 10, with a score of: 0.47744979824016
WordScorePoS
evidence0.12939607756667NN
review0NN
study0NN
undertake0VB
report0NN
environmental0.0237821918091848JJ
infection0NN
malnutrition0NN

Label: 3, with a score of: 0.476882062768339
WordScorePoS
evidence0NN
review0NN
study0NN
undertake0VB
report0.0307735781890304NN
environmental0JJ
infection0.122222546933424NN
malnutrition0NN

Label: 5, with a score of: 0.429305672428974
WordScorePoS
evidence0NN
review0.0688661930304451NN
study0NN
undertake0.0688661930304451VB
report0NN
environmental0JJ
infection0NN
malnutrition0NN

Label: 1, with a score of: 0.367301873482178
WordScorePoS
evidence0NN
review0NN
study0NN
undertake0VB
report0NN
environmental0.0442083771593746JJ
infection0NN
malnutrition0.0736315832425121NN

Label: 12, with a score of: 0.314208508497084
WordScorePoS
evidence0NN
review0NN
study0NN
undertake0VB
report0.0409791940864438NN
environmental0.0598270388037045JJ
infection0NN
malnutrition0NN

Contributions of This Report This report reemphasizes the window of opportunity highlighted in the World Bank nutrition report pointing to critical period in the life cycle of child from the womb to the age of about two years World Bank

Label: 2, with a score of: 0.686387638117625
WordScorePoS
contribution0NN
report0NN
opportunity0.0261926252110933NN
world0.0124838525528648NN
bank0.0881366997038154NN
nutrition0.175025014152344NN
critical0JJ
period0.0440683498519077NN
life0NN
cycle0NN
child0.0546336178945768NN
age0.0365427838531249NN

Label: 3, with a score of: 0.402411330368619
WordScorePoS
contribution0NN
report0.0307735781890304NN
opportunity0NN
world0.00087176582269799NN
bank0NN
nutrition0NN
critical0JJ
period0NN
life0.0250390290383647NN
cycle0NN
child0.10682408961305NN
age0.0893142758861673NN

Label: 12, with a score of: 0.391526717531413
WordScorePoS
contribution0NN
report0.0409791940864438NN
opportunity0NN
world0.00464349782489754NN
bank0NN
nutrition0NN
critical0JJ
period0.0409791940864438NN
life0.0250071479597636NN
cycle0.108503934593034NN
child0NN
age0NN

With ENVIRONMENTAL HEALTH AND CHILD SURVIVAL research evidence from various studies this report demonstrates how exposures to environmental health risks jeopardize the health and nutritional status of young children

Label: 3, with a score of: 0.741931980707889
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
research0.0175975629039954NN
evidence0NN
study0NN
report0.0307735781890304NN
exposure0NN
risk0.0703902516159815NN
nutritional0JJ
status0NN

Label: 10, with a score of: 0.323977955538801
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
child0.0242343960710022NN
research0NN
evidence0.12939607756667NN
study0NN
report0NN
exposure0NN
risk0NN
nutritional0JJ
status0.0488696285210061NN

Poor environmental management and bad sanitation expose pregnant women to both malaria and hookworm infections

Label: 6, with a score of: 0.651267409767843
WordScorePoS
poor0.0642010940957526JJ
environmental0JJ
management0.0428007293971684NN
bad0.0683326727248364JJ
sanitation0.334686906581616NN
pregnant0JJ
woman0.0127979231406811NN
malaria0NN
infection0NN

Label: 3, with a score of: 0.500491382350922
WordScorePoS
poor0JJ
environmental0JJ
management0.0127591822694525NN
bad0JJ
sanitation0.0249430985430622NN
pregnant0JJ
woman0.0381514605760894NN
malaria0.20370424488904NN
infection0.122222546933424NN

Label: 1, with a score of: 0.298860483284853
WordScorePoS
poor0.150659516460257JJ
environmental0.0442083771593746JJ
management0NN
bad0JJ
sanitation0NN
pregnant0JJ
woman0.0450489732120807NN
malaria0NN
infection0NN

Label: 5, with a score of: 0.276516027516996
WordScorePoS
poor0JJ
environmental0JJ
management0NN
bad0JJ
sanitation0NN
pregnant0JJ
woman0.221979360474357NN
malaria0NN
infection0NN

Left untreated these infections lead to permanent growth faltering lowered immunity and increased mortality for these women children

Label: 3, with a score of: 0.711129245904026
WordScorePoS
untreated0JJ
infection0.122222546933424NN
lead0.025518364538905NN
growth0NN
increase0.0143984997539974NN
mortality0.276962203701274NN
woman0.0381514605760894NN
child0.10682408961305NN

Label: 8, with a score of: 0.434068846894565
WordScorePoS
untreated0JJ
infection0NN
lead0.0504071033101074NN
growth0.208565600657229NN
increase0.00711043475673939NN
mortality0NN
woman0.0452169560888236NN
child0.0452169560888236NN

Label: 5, with a score of: 0.295959163398035
WordScorePoS
untreated0JJ
infection0NN
lead0NN
growth0NN
increase0.00402768349408688NN
mortality0NN
woman0.221979360474357NN
child0.0170753354211044NN

In early infancy improper feeding practices and poor sanitation have pernicious synergistic effect on the child nutritional status

Label: 6, with a score of: 0.719464685526824
WordScorePoS
practice0NN
poor0.0642010940957526JJ
sanitation0.334686906581616NN
effect0NN
child0.0255958462813622NN
nutritional0JJ
status0NN

Label: 1, with a score of: 0.331709552638708
WordScorePoS
practice0NN
poor0.150659516460257JJ
sanitation0NN
effect0NN
child0.0450489732120807NN
nutritional0JJ
status0NN

Label: 2, with a score of: 0.401793283617095
WordScorePoS
practice0.0252000451111224NN
poor0.0548141757796873JJ
sanitation0NN
effect0.0440683498519077NN
child0.0546336178945768NN
nutritional0.0583416713841148JJ
status0NN

Many of these impacts on child growth also result in negative cognition and learning impacts as well as chronic diseases later in life

Label: 3, with a score of: 0.48399464469182
WordScorePoS
impact0NN
child0.10682408961305NN
growth0NN
result0NN
learn0VB
chronic0JJ
disease0.215415047323213NN
life0.0250390290383647NN

Label: 4, with a score of: 0.464612167395742
WordScorePoS
impact0NN
child0.076326555629389NN
growth0NN
result0NN
learn0.244520809605025VB
chronic0JJ
disease0NN
life0.0125233923809486NN

Label: 8, with a score of: 0.370924625105119
WordScorePoS
impact0NN
child0.0452169560888236NN
growth0.208565600657229NN
result0NN
learn0VB
chronic0JJ
disease0NN
life0.0123650647908625NN

Label: 6, with a score of: 0.42068354233308
WordScorePoS
impact0.0181797964452808NN
child0.0255958462813622NN
growth0NN
result0.0683326727248364NN
learn0VB
chronic0.0683326727248364JJ
disease0.103230094596636NN
life0NN

Although considerable progress has been made this report calls attention to the potential of untapped environmental health actions to complement existing health infrastructure and environmental management strategies in the developing world

Label: 3, with a score of: 0.516994395096189
WordScorePoS
progress0.0449274832628543NN
report0.0307735781890304NN
attention0NN
potential0NN
environmental0JJ
health0.191387734041787NN
action0NN
complement0NN
exist0VB
infrastructure0NN
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strategy0.0149758277542848NN
develop0VB
world0.00087176582269799NN

Label: 9, with a score of: 0.419866335701315
WordScorePoS
progress0.0221298700466866NN
report0NN
attention0NN
potential0.0454743001434393NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
action0.0135141354781442NN
complement0NN
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infrastructure0.192202909044225NN
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strategy0NN
develop0VB
world0.00257642711761688NN

Label: 11, with a score of: 0.405585194455822
WordScorePoS
progress0NN
report0NN
attention0.08955644059472NN
potential0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
action0NN
complement0NN
exist0.04477822029736VB
infrastructure0.0194583992186006NN
management0.0687164195125178NN
strategy0NN
develop0VB
world0.00626002771693937NN

Label: 12, with a score of: 0.362450805619927
WordScorePoS
progress0NN
report0.0409791940864438NN
attention0NN
potential0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
action0.0121782716594324NN
complement0NN
exist0.0332151194779746VB
infrastructure0.028867295332595NN
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strategy0NN
develop0VB
world0.00464349782489754NN

Current child survival strategies in developing countries focus on case management and treatment neglecting primary prevention especially as it relates to reducing exposure to infections

Label: 3, with a score of: 0.706690295705595
WordScorePoS
current0JJ
child0.10682408961305NN
strategy0.0149758277542848NN
develop0VB
country0NN
focus0NN
management0.0127591822694525NN
treatment0.0624189222007589NN
neglect0.0407408489778079NN
primary0.0108390366114755JJ
prevention0.0923207345670913NN
reduce0.01675146888405VB
exposure0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.332845762881094
WordScorePoS
current0JJ
child0.0450489732120807NN
strategy0.0442083771593746NN
develop0VB
country0NN
focus0NN
management0NN
treatment0NN
neglect0NN
primary0JJ
prevention0NN
reduce0.0164833460638534VB
exposure0.120266261535276NN
infection0NN

The evidence of the impacts of environmental risks and subsequent infections on child malnutrition makes correcting the current neglect of environmental health in child survival and child health strategies even more imperative in developing countries

Label: 3, with a score of: 0.733846535192107
WordScorePoS
evidence0NN
impact0NN
environmental0JJ
risk0.0703902516159815NN
infection0.122222546933424NN
child0.10682408961305NN
malnutrition0NN
correct0JJ
current0JJ
neglect0.0407408489778079NN
health0.191387734041787NN
strategy0.0149758277542848NN
develop0VB
country0NN

Label: 10, with a score of: 0.25504164053441
WordScorePoS
evidence0.12939607756667NN
impact0NN
environmental0.0237821918091848JJ
risk0NN
infection0NN
child0.0242343960710022NN
malnutrition0NN
correct0JJ
current0JJ
neglect0NN
health0.0405241466500776NN
strategy0NN
develop0VB
country0NN

Label: 1, with a score of: 0.303348487924923
WordScorePoS
evidence0NN
impact0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN
infection0NN
child0.0450489732120807NN
malnutrition0.0736315832425121NN
correct0JJ
current0JJ
neglect0NN
health0NN
strategy0.0442083771593746NN
develop0VB
country0NN

Environmental health actions supplement existing strategies addressing child health

Label: 3, with a score of: 0.740571456225776
WordScorePoS
environmental0JJ
health0.191387734041787NN
action0NN
exist0VB
strategy0.0149758277542848NN
address0NN
child0.10682408961305NN

Label: 10, with a score of: 0.305704031483124
WordScorePoS
environmental0.0237821918091848JJ
health0.0405241466500776NN
action0.0145231653596925NN
exist0VB
strategy0NN
address0.064698038783335NN
child0.0242343960710022NN

An analysis of results from Fewtrell and others shows that environmental health interventions have multiplier effect on mortality investments addressing environmental risks for example lack of water and sanitation pay off with more than just their direct effect on disease for example reducing diarrhea

Label: 6, with a score of: 0.683007104923694
WordScorePoS
result0.0683326727248364NN
environmental0JJ
health0NN
intervention0NN
effect0NN
mortality0NN
investment0NN
address0NN
risk0NN
lack0.0214003646985842NN
water0.556409482163189NN
sanitation0.334686906581616NN
pay0.0295155485671997NN
direct0JJ
disease0.103230094596636NN
reduce0.00936547854413134VB

Label: 3, with a score of: 0.532121845213067
WordScorePoS
result0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
effect0NN
mortality0.276962203701274NN
investment0NN
address0NN
risk0.0703902516159815NN
lack0NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
pay0NN
direct0JJ
disease0.215415047323213NN
reduce0.01675146888405VB

Label: 12, with a score of: 0.22068957493569
WordScorePoS
result0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
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mortality0NN
investment0NN
address0NN
risk0NN
lack0NN
water0.186896403054502NN
sanitation0NN
pay0NN
direct0JJ
disease0NN
reduce0.022306853314744VB

This finding has important consequences for developing countries seeking to invest in environmental health interventions their budgets will stretch further because of the nature of the externalities associated with such interventions

Label: 3, with a score of: 0.62807932372174
WordScorePoS
develop0VB
country0NN
seek0VB
invest0VB
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
nature0NN

Label: 12, with a score of: 0.590548411039926
WordScorePoS
develop0VB
country0NN
seek0VB
invest0VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
nature0.162755901889551NN

Label: 1, with a score of: 0.378580770607155
WordScorePoS
develop0VB
country0NN
seek0.120266261535276VB
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environmental0.0442083771593746JJ
health0NN
intervention0NN
nature0NN

Therefore governments in developing countries have an enormous opportunity to incorporate environmental health interventions in existing strategies that affect child health and to provide bigger bang for the buck in terms of health improvements

Label: 3, with a score of: 0.727854788460056
WordScorePoS
government0NN
develop0VB
country0NN
opportunity0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
exist0VB
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child0.10682408961305NN
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term0NN
improvement0NN

Label: 17, with a score of: 0.273215092742656
WordScorePoS
government0.048933054487825NN
develop0VB
country0NN
opportunity0NN
environmental0JJ
health0NN
intervention0NN
exist0.0599173571845643VB
strategy0.017987180284335NN
affect0VB
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provide0.00601568197638796VB
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As has been discussed in this report environmental health actions add value to existing programs for child care micronutrient supplementation and immunization

Label: 3, with a score of: 0.708514343974851
WordScorePoS
report0.0307735781890304NN
environmental0JJ
health0.191387734041787NN
action0NN
add0VB
exist0VB
child0.10682408961305NN
care0.104031537001265NN

Label: 5, with a score of: 0.340719823079529
WordScorePoS
report0NN
environmental0JJ
health0.0571058915334038NN
action0.0409315617631NN
add0VB
exist0VB
child0.0170753354211044NN
care0.0931221694711702NN

They can also be used to adapt environmental management programs in developing countries such as those relating to vector control as well as to form the basis of adjustments to strategies in the water sanitation and rural energy sectors to enhance health outcomes

Label: 6, with a score of: 0.670685707977513
WordScorePoS
environmental0JJ
management0.0428007293971684NN
develop0VB
country0NN
control0NN
form0NN
basis0NN
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water0.556409482163189NN
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rural0JJ
energy0.0153390539205676NN
sector0.0214003646985842NN
enhance0VB
health0NN
outcome0NN

Label: 7, with a score of: 0.354764358249886
WordScorePoS
environmental0JJ
management0NN
develop0VB
country0NN
control0NN
form0NN
basis0NN
strategy0NN
water0NN
sanitation0NN
rural0JJ
energy0.494617163780726NN
sector0NN
enhance0.0188084899376888VB
health0NN
outcome0NN

Label: 12, with a score of: 0.321743822334689
WordScorePoS
environmental0.0598270388037045JJ
management0.0339811641917276NN
develop0VB
country0NN
control0NN
form0NN
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water0.186896403054502NN
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rural0JJ
energy0.133960988253756NN
sector0.0169905820958638NN
enhance0VB
health0.0339811641917276NN
outcome0NN

Label: 3, with a score of: 0.20946890141953
WordScorePoS
environmental0JJ
management0.0127591822694525NN
develop0VB
country0NN
control0.020806307400253NN
form0NN
basis0NN
strategy0.0149758277542848NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
rural0JJ
energy0NN
sector0NN
enhance0VB
health0.191387734041787NN
outcome0NN

Label: 2, with a score of: 0.172831164648302
WordScorePoS
environmental0JJ
management0NN
develop0VB
country0NN
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form0.0428913409252473NN
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water0NN
sanitation0NN
rural0.148975141598503JJ
energy0.0130963126055467NN
sector0.0182713919265625NN
enhance0.0268922747178632VB
health0NN
outcome0NN

Label: 16, with a score of: 0.10920802839761
WordScorePoS
environmental0JJ
management0NN
develop0VB
country0NN
control0NN
form0.158049144643351NN
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water0NN
sanitation0NN
rural0JJ
energy0NN
sector0NN
enhance0VB
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outcome0NN

Revised country level estimates show that when malnutrition mediated health effects attributed to environmental health risks are included the total costs are at least percent higher for both Ghana and Pakistan

Label: 3, with a score of: 0.714474168310345
WordScorePoS
country0NN
level0NN
estimate0.059903311017139NN
malnutrition0NN
health0.191387734041787NN
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environmental0JJ
risk0.0703902516159815NN
include0VB
total0NN
cost0NN

Label: 12, with a score of: 0.31672443214283
WordScorePoS
country0NN
level0.00513687014008325NN
estimate0.0199423462679015NN
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health0.0339811641917276NN
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environmental0.0598270388037045JJ
risk0NN
include0VB
total0.0468670845659596NN
cost0.0277064208763707NN

The longer term effects of malnutrition partly attributed to environment related infections on education and income are estimated to add another to percent in terms of annual costs

Label: 10, with a score of: 0.43103685587691
WordScorePoS
term0.0396106020715138NN
effect0NN
malnutrition0NN
environment0NN
related0JJ
infection0NN
education0.0121171980355011NN
income0.166475342664294NN
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add0VB
cost0.0660824365173543NN

Label: 17, with a score of: 0.422623333586244
WordScorePoS
term0.149793392961411NN
effect0NN
malnutrition0NN
environment0NN
related0JJ
infection0NN
education0NN
income0.017987180284335NN
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cost0NN

Label: 4, with a score of: 0.404781308211511
WordScorePoS
term0NN
effect0NN
malnutrition0NN
environment0.0299609328954485NN
related0JJ
infection0NN
education0.244244978014045NN
income0NN
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add0VB
cost0NN

Label: 9, with a score of: 0.308987638850789
WordScorePoS
term0NN
effect0.0454743001434393NN
malnutrition0NN
environment0.0221298700466866NN
related0.00925008066007716JJ
infection0NN
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add0VB
cost0NN

The total annual cost attributed to environmental health risks including all CONCLUSION malnutrition effects such as higher education costs are estimated to be as high as percent of Ghana or Pakistan gross domestic product

Label: 3, with a score of: 0.427865609478935
WordScorePoS
total0NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
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education0.0152605842304358NN
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gross0JJ
domestic0JJ
product0NN

Label: 4, with a score of: 0.348200345052909
WordScorePoS
total0NN
cost0NN
environmental0JJ
health0NN
risk0NN
include0VB
conclusion0NN
malnutrition0NN
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gross0JJ
domestic0JJ
product0NN

Label: 9, with a score of: 0.384778169362302
WordScorePoS
total0.0260040237236563NN
cost0NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
risk0NN
include0VB
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malnutrition0NN
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gross0.030745604615229JJ
domestic0.0520080474473126JJ
product0.0442597400933733NN

Label: 12, with a score of: 0.312552712682892
WordScorePoS
total0.0468670845659596NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
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malnutrition0NN
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education0.0101607690729067NN
estimate0.0199423462679015NN
gross0JJ
domestic0JJ
product0.0199423462679015NN

Given this considerable social and economic burden policy makers in developing countries where malnutrition and poor environmental conditions coexist should place environmental health interventions high on the policy agenda

Label: 1, with a score of: 0.539518311519297
WordScorePoS
social0.112994637345193JJ
economic0.0959899298575892JJ
burden0NN
policy0.0450489732120807NN
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Furthermore as developing countries strive to meet several of their commitments for the Millennium Development Goals these interventions will remain critical for addressing poverty reduction and child mortality

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Growing evidence indicates the need to mainstream environmental health interventions in developing countries child survival strategies

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With environmental health having fallen through the cracks in the development agenda however policy makers in those countries will have to make renewed effort to revitalize the environmental health content within existing child survival programs nutrition initiatives and infrastructure projects

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Anecdotal evidence of such efforts is beginning to emerge in developing countries

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Common criteria for successful implementation include obtaining high level political commitment involving and empowering communities allocating responsibilities and resources at the local level and finding balance between private and public sector roles

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Finally successful environmental health governance requires strong institutional underpinnings

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This report discusses through an institutional lens the roles that national and local governments can play in delivering and managing environmental health interventions

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Next Steps In many ways this report represents first step toward providing policy makers with the epidemiological economic and experiential evidence to incorporate environmental health in the child survival agenda

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However in each of the three main sections of the report additional research and studies will help donors and governments in developing countries choose to invest in appropriate environmental health interventions

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The epidemiological evidence presented in this report reaffirms the importance of environmental health for child survival especially when considering the links through malnutrition

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Further research on the environmental health impacts during pregnancy additional disease transmission pathways and better relative risk estimates will help improve disease burden and costing estimates while informing governments about appropriate programs

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For example in Sub Saharan Africa malaria and hookworm infections coexist to cause anemia and subsequent growth retardation of the fetus in pregnant women

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Communitywide investments to improve water resources management use of insecticide treated nets and indoor residual spraying and improved sanitation facilities would help improve birth weight

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL This report demonstrates the substantial burden and consequent economic costs associated with environmental health risks but important questions remain How should governments prioritize among the different environmental health infrastructure nutrition and child survival interventions to improve child health

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What are the cost benefit ratios and the levels of cost effectiveness of individual interventions

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Some research on this subject has provided answers at the global level with hygiene promotion measures emerging as the most cost effective intervention Laxminarayan Chow and Shahid Salles

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Carrying out such cost effectiveness and cost benefit analyses at country level is the next step in guiding decision makers in specific countries in prioritizing among the various available interventions

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Some recent analyses in Colombia and Peru have begun to explore the ranking environmental health interventions through cost benefit analyses World Bank

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In addition to conducting economic analyses governments in developing countries need to look toward implementing specific environmental health actions

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The effectiveness of such interventions ultimately depends on the enabling environment in the country which highlights the need to assess institutional mandates and capacities for addressing environmental health issues regulations on environmental health and availability of budgets Poverty Environment Partnership

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However one size fits all solution will not work and policy makers will need to look beyond the generic roles and responsibilities for better environmental health governance discussed in this report

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WordScorePoS
size0NN
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Label: 10, with a score of: 0.467794072012671
WordScorePoS
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Label: 12, with a score of: 0.386052943480874
WordScorePoS
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Label: 5, with a score of: 0.359158986324171
WordScorePoS
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An important next step would be to carry out an in depth institutional analysis at country level to better understand the coordination mechanisms between ministries and the ways mandates and budgets are assigned

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WordScorePoS
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Label: 13, with a score of: 0.469773327405971
WordScorePoS
institutional0.0828215106044499JJ
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Such an understanding is critical for environmental health an issue that is inherently multisectoral and that requires collaborations across health environment and infrastructure ministries

Label: 3, with a score of: 0.571572310578721
WordScorePoS
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Label: 9, with a score of: 0.537422084480419
WordScorePoS
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Label: 12, with a score of: 0.397142841587887
WordScorePoS
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Temporality is also an important consideration in how governments choose between various interventions that address child survival because the costs of programs are often incurred in the short term and are front loaded whereas the benefits especially those relating to cognition and learning are spread over the long term

Label: 17, with a score of: 0.572740532132633
WordScorePoS
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Label: 4, with a score of: 0.527264934131704
WordScorePoS
government0NN
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In the absence of appropriate economic analysis at the country level governments may be tempted to choose interventions that are cheaper in the short term such as oral rehydration programs rather than the more expensive water and sanitation programs even though the latter may have greater benefits over the long term

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WordScorePoS
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Label: 17, with a score of: 0.332358484200733
WordScorePoS
economic0JJ
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Label: 12, with a score of: 0.265566294414137
WordScorePoS
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Label: 8, with a score of: 0.124796225760246
WordScorePoS
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Additionally over the longer term environmental health concerns are expected to grow

Label: 3, with a score of: 0.512057259583402
WordScorePoS
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Label: 17, with a score of: 0.400771735385991
WordScorePoS
additionally0RB
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Label: 12, with a score of: 0.430766980105321
WordScorePoS
additionally0RB
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Label: 10, with a score of: 0.386451658688464
WordScorePoS
additionally0RB
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As the world climate changes diseases such as diarrhea and malaria among other important health burdens that are the result of environmental risk factors are likely to worsen particularly for the poor and in developing countries Campbell Lendrum Corvalán and Neira IPCC

Label: 3, with a score of: 0.739061082221881
WordScorePoS
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Label: 13, with a score of: 0.320224876532981
WordScorePoS
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Label: 1, with a score of: 0.311176299208515
WordScorePoS
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Label: 6, with a score of: 0.334406228646942
WordScorePoS
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Changing CONCLUSION temperature and precipitation will also affect agricultural production and threaten food security thus having implications for malnutrition

Label: 2, with a score of: 0.698947084234478
WordScorePoS
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Label: 13, with a score of: 0.563536257486337
WordScorePoS
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Label: 12, with a score of: 0.282508555823967
WordScorePoS
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Therefore scaling up preventive environmental health interventions such as clean water and sanitation to reduce the current burden of disease is prudent investment Campbell Lendrum Corvalán and Neira

Label: 6, with a score of: 0.798897783551774
WordScorePoS
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Label: 3, with a score of: 0.421777151633724
WordScorePoS
scale0NN
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Label: 12, with a score of: 0.258630285278693
WordScorePoS
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Label: 7, with a score of: 0.132118663009852
WordScorePoS
scale0NN
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Given the multisectoral nature of environmental health issues the advocacy and regulatory role of the health sector and the supporting roles of other sectors for example environment infrastructure agriculture and education in promoting and delivering environmental health actions need to be revitalized

Label: 12, with a score of: 0.476048547344305
WordScorePoS
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Label: 3, with a score of: 0.472714403284542
WordScorePoS
nature0NN
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Label: 9, with a score of: 0.418535271369324
WordScorePoS
nature0NN
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Label: 4, with a score of: 0.21446950095679
WordScorePoS
nature0NN
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Label: 2, with a score of: 0.179950597068069
WordScorePoS
nature0NN
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Label: 5, with a score of: 0.341759892417975
WordScorePoS
nature0NN
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Without focused and targeted attention to improving environmental health governments and donors are losing out on the significant opportunities to make dramatic changes in the child health scenario in the world poorest countries

Label: 3, with a score of: 0.589938883216207
WordScorePoS
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Label: 11, with a score of: 0.356331942567393
WordScorePoS
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Label: 10, with a score of: 0.335481811576113
WordScorePoS
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Ultimately good environmental health governance is about how policy makers in the poorest countries develop mechanisms to pick up signals on environmental risks and then find ways to translate these findings into appropriate and well targeted actions

Label: 17, with a score of: 0.459729892467682
WordScorePoS
ultimately0RB
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Label: 3, with a score of: 0.384669329915222
WordScorePoS
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Label: 10, with a score of: 0.395785625835949
WordScorePoS
ultimately0RB
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These governments will also need to adjust their policies to address environmental health outcomes and set up institutional mechanisms to successfully implement interventions

Label: 17, with a score of: 0.696715143558504
WordScorePoS
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Label: 3, with a score of: 0.366245579096117
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Label: 10, with a score of: 0.306537321041687
WordScorePoS
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Finally the creation of long term constituencies within country will help to continually raise attention to issues related to the environment health and poverty and to promote social accountability among public officials for effective action on these issues Poverty Environment Partnership

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Label: 1, with a score of: 0.481002011923072
WordScorePoS
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Label: 8, with a score of: 0.362266941292034
WordScorePoS
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Label: 3, with a score of: 0.211884088421391
WordScorePoS
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Label: 10, with a score of: 0.300340970917785
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concerted and continuous effort is needed on behalf of both developed and developing countries to ensure that environmental health is placed high on the development agenda and that corresponding interventions are financed and undertaken to improve children survival and development potential

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Label: 16, with a score of: 0.326101579894622
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P E D X Technical Review of Cohort Studies Background The World Health Organization WHO monograph by Scrimshaw Taylor and Gordon initiated lengthy discussion on whether repeated infections in childhood resulted in permanent growth faltering and stunting in adulthood

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Label: 8, with a score of: 0.486821572589574
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Results from observational cohort follow up studies on effects of infections over time and ultimately over generations have provided evidence to stimulate the debate

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Label: 9, with a score of: 0.472021260252141
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Label: 3, with a score of: 0.410325776317915
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By the time the WHO monograph was published extensive microbiological immunological and physiological studies partly based on human experiments favored the idea that all infections contribute to growth faltering but the long term effects of infections on nutritional status were still lacking Scrimshaw

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Label: 17, with a score of: 0.351612354458103
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Label: 10, with a score of: 0.399543545581884
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Diarrheal diseases are very common from infancy up to early childhood

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WordScorePoS
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Label: 6, with a score of: 0.331349521640667
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Unlike upper respiratory infections which are relatively uncommon in early infancy because of maternal antibodies Nair and others Sato and others diarrheal diseases affect the gastrointestinal tract of the child from birth onward causing malabsorption

Label: 3, with a score of: 0.918886265747683
WordScorePoS
infection0.122222546933424NN
maternal0.184641469134183JJ
disease0.215415047323213NN
affect0.00625975725959118VB
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For this reason diarrheal diseases have been particularly studied to investigate their impact on growth faltering Scrimshaw Stephensen

Label: 3, with a score of: 0.577908509325319
WordScorePoS
disease0.215415047323213NN
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growth0NN

Label: 8, with a score of: 0.559533035737799
WordScorePoS
disease0NN
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growth0.208565600657229NN

Label: 6, with a score of: 0.325714521902029
WordScorePoS
disease0.103230094596636NN
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Search Strategy and Selection Criteria For this study an initial review of cohort studies published on Pubmed that linked infections and malnutrition underweight wasting and stunting was undertaken

Label: 3, with a score of: 0.632167926820801
WordScorePoS
environmental0JJ
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malnutrition0NN
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Label: 12, with a score of: 0.337332683043988
WordScorePoS
environmental0.0598270388037045JJ
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child0NN
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waste0.138532104381853NN
stunt0NN
undertake0VB

Label: 2, with a score of: 0.343852649343768
WordScorePoS
environmental0JJ
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malnutrition0.0357189919948307NN
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undertake0VB

Label: 5, with a score of: 0.307675359729762
WordScorePoS
environmental0JJ
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undertake0.0688661930304451VB

In all cohort studies conducted in developing countries table A

Label: 10, with a score of: 0.781012713109308
WordScorePoS
study0NN
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were identified one recent and very large case control study in Bangladesh Chisti and others was also included

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WordScorePoS
identify0VB
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Label: 1, with a score of: 0.496364866607859
WordScorePoS
identify0VB
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Studies that reported the effects of infections on underweight status weight for age only that is those that lacked information on stunting measured by height for age were also included

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WordScorePoS
study0NN
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age0.112994637345193NN
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include0VB

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WordScorePoS
study0NN
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height0NN
include0VB

Label: 2, with a score of: 0.394949923645702
WordScorePoS
study0NN
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height0NN
include0VB

One cohort study that was included described only the natural growth history of patients with persistent diarrhea Valentiner Branth and others and had no control group

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WordScorePoS
study0NN
include0VB
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growth0.208565600657229NN
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persistent0JJ
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Label: 1, with a score of: 0.445658669582298
WordScorePoS
study0NN
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natural0.0376648791150643JJ
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control0.0614198493690006NN

Label: 15, with a score of: 0.393729354144263
WordScorePoS
study0.0517339898971162NN
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natural0.016202004209163JJ
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persistent0.0390772412228479JJ
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One study merely descriptively associated diarrhea episodes and development of underweight Schorling and others

Label: 0, with a score of: 1

These studies were included whether or not associations of diarrheal and other diseases with malnutrition were separated

Label: 3, with a score of: 0.777202624072109
WordScorePoS
study0NN
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malnutrition0NN

Label: 6, with a score of: 0.523387964580197
WordScorePoS
study0NN
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Published experimental studies and their systematic reviews that report results from deworming trials undertaken after recent meta analysis Dickson and others were separately included to allow inferences to be drawn about whether the elimination of soil transmitted helminths that cause loss of appetite malabsorption or nutrient losses affect the nutritional status of individuals TaylorRobinson Jones and Garner

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Findings and Discussion Epidemiological studies typically examine associations between an exposure variable and health outcome

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WordScorePoS
study0NN
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WordScorePoS
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Austin Bradford Hill recognized the importance of moving from association to causation as necessary step for taking preventive action against environmental causes of disease Lucas and McMichael

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WordScorePoS
recognize0VB
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Hill set out nine viewpoints or guidelines against which an epidemiological association might be assessed when attempting to reach an appropriate conclusion on causation strength of association consistency of results specificity dose response temporality biological gradient plausibility coherence experiment and analogy

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WordScorePoS
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In this review of the literature some of the more important of these criteria are used as framework for evaluating whether infections cause growth faltering

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WordScorePoS
review0NN
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Label: 3, with a score of: 0.391368291082297
WordScorePoS
review0NN
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Label: 10, with a score of: 0.328780844820969
WordScorePoS
review0NN
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Strength of Association The cohort studies use heterogeneous analyses and different parameters to study infection attributable growth faltering

Label: 8, with a score of: 0.712659808372735
WordScorePoS
study0NN
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growth0.208565600657229NN

Label: 3, with a score of: 0.417629257182983
WordScorePoS
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One often finds somewhat weak associations in these studies

Label: 15, with a score of: 1
WordScorePoS
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One should bear in mind the following issues which lead to difficulties in establishing an infection attributable fraction of poor growth

Label: 8, with a score of: 0.5483173149869
WordScorePoS
bear0NN
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Label: 1, with a score of: 0.428975869718761
WordScorePoS
bear0NN
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poor0.150659516460257JJ
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Label: 3, with a score of: 0.538139566145104
WordScorePoS
bear0.0814816979556159NN
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The internal comparison group or merely diarrhea free period in the reviewed studies is often not infection free

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WordScorePoS
free0.0898760357768464JJ
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Label: 3, with a score of: 0.401298180979683
WordScorePoS
free0JJ
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Thus asymptomatic children may TECHNICAL REVIEW OF COHORT STUDIES

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WordScorePoS
child0.076326555629389NN
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Label: 3, with a score of: 0.364659709284423
WordScorePoS
child0.10682408961305NN
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have endemic diarrheagenic bacteria to percent according to Nguyen and others

Label: 0, with a score of: 1

Schorling and others Steiner and others as well as carry parasites and protozoa Checkley and others Prado and others

Label: 0, with a score of: 1

These children have been shown to present with pathological damage in the gut which results in subsequent growth faltering Checkley and others Steiner and others

Label: 8, with a score of: 0.703558977454275
WordScorePoS
child0.0452169560888236NN
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growth0.208565600657229NN

Label: 10, with a score of: 0.377078166992108
WordScorePoS
child0.0242343960710022NN
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A cohort follow up study of Gambian infants has provided evidence that such damage which results from malabsorption disease likely caused by unhygienic conditions Lim causes percent of the loss in weight gain in developing countries even if infants were breastfed Campbell Elia and Lunn

Label: 3, with a score of: 0.479482304879779
WordScorePoS
study0NN
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Label: 10, with a score of: 0.288016692821736
WordScorePoS
study0NN
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In an earlier study in rural Gambia infants between the ages of and months were found to have this malabsorption in the gut for percent of the time but showed diarrheal symptoms only

Label: 2, with a score of: 0.764202507418785
WordScorePoS
study0NN
rural0.148975141598503JJ
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percent of the time Lunn NorthropClewes and Downes

Label: 10, with a score of: 0.829051546962935
WordScorePoS
time0.0607862199751165NN

In earlier studies in Guatemala and Nigeria Martorell Yarbrough and others Morley Bicknell and Woodland and in more recent study in Malawi Maleta and others the comparison group was also exposed to relatively high morbidity burden which obviously diminishes the association between growth faltering and infections

Label: 8, with a score of: 0.679602860586381
WordScorePoS
study0NN
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In most studies the children being studied are subject to nutritional interventions especially breastfeeding promotion or receive appropriate medical case management

Label: 3, with a score of: 0.610540359680955
WordScorePoS
study0NN
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These interventions and treatments are also likely to mask the effects of diarrhea on growth because it becomes difficult to observe the natural history of growth faltering attributable to infections under these circumstances

Label: 8, with a score of: 0.736514294819302
WordScorePoS
intervention0NN
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Label: 3, with a score of: 0.355910375683682
WordScorePoS
intervention0.0407408489778079NN
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Another reason for difficulties in attributing growth faltering to infections lies in the methodology for research studies

Label: 8, with a score of: 0.582405555440319
WordScorePoS
difficulty0NN
growth0.208565600657229NN
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Label: 9, with a score of: 0.531185383335047
WordScorePoS
difficulty0.0602029956716497NN
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Label: 3, with a score of: 0.390438348773628
WordScorePoS
difficulty0NN
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Label: 10, with a score of: 0.312145003232126
WordScorePoS
difficulty0NN
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Many studies for example Briend and others do not start follow up from early infancy

Label: 15, with a score of: 1
WordScorePoS
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This lessens the ability of investigators to find the effects of infections on growth faltering Checkley and others see also the discussion of early infancy in chapter

Label: 8, with a score of: 0.772234334666269
WordScorePoS
lessen0VB
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Label: 3, with a score of: 0.350411109366752
WordScorePoS
lessen0VB
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Label: 10, with a score of: 0.320479382937599
WordScorePoS
lessen0VB
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Furthermore the environmental effects in the fetal period are not adequately considered in these cohort studies

Label: 12, with a score of: 0.568313037149475
WordScorePoS
environmental0.0598270388037045JJ
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Label: 2, with a score of: 0.496886294199589
WordScorePoS
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Many infections can cause intrauterine growth restriction Graham and others but recent robust ecological van Geertruyden and others and analytic Watson Jones and others evidence reveals that malaria during pregnancy has dramatic adverse effects on fetal and newborn survival and related nutritional status at birth especially in Sub Saharan Africa

Label: 3, with a score of: 0.69433986220067
WordScorePoS
infection0.122222546933424NN
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saharan0.0299516555085695JJ
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Label: 10, with a score of: 0.472955143094325
WordScorePoS
infection0NN
growth0.11178243319132NN
restriction0NN
evidence0.12939607756667NN
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Label: 8, with a score of: 0.316965035002143
WordScorePoS
infection0NN
growth0.208565600657229NN
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Consistency Infections contribute to growth faltering

Label: 8, with a score of: 0.704393877415522
WordScorePoS
infection0NN
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growth0.208565600657229NN

Label: 3, with a score of: 0.412785298585866
WordScorePoS
infection0.122222546933424NN
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growth0NN

Label: 10, with a score of: 0.37752563842961
WordScorePoS
infection0NN
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This proposition is supported by of the reviewed cohort studies

Label: 17, with a score of: 0.607486598781674
WordScorePoS
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Label: 5, with a score of: 0.509736367949191
WordScorePoS
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Label: 15, with a score of: 0.441762557348509
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In the three studies in which the effects were largely ENVIRONMENTAL HEALTH AND CHILD SURVIVAL not found Alvarado and others Cohen and others Kolsteren Kusin and Kardjati the results can be explained by the well established masking effects of breastfeeding Brown

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WordScorePoS
study0NN
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Studies by Briend and others and later by Moy and others paid attention to the timing of infections within the follow up periods

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WordScorePoS
study0NN
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Label: 11, with a score of: 0.509203019847089
WordScorePoS
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Growth periods were analyzed as statistical units rather than by individual children

Label: 8, with a score of: 0.640930354114218
WordScorePoS
growth0.208565600657229NN
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Label: 10, with a score of: 0.506907382059435
WordScorePoS
growth0.11178243319132NN
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Label: 2, with a score of: 0.312915757467738
WordScorePoS
growth0.0252000451111224NN
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The results demonstrated that the effect on growth faltering was observed to be corrected by catch up growth among children experiencing watery nonchronic diarrhea if enough time had elapsed since diarrhea episodes

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WordScorePoS
result0NN
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Label: 10, with a score of: 0.465880008235744
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result0NN
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Label: 2, with a score of: 0.340768339887339
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However even those studies have agreed that chronic diarrhea that is diarrhea that persists for greater than percent of time has irreversible effects

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WordScorePoS
study0NN
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WordScorePoS
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The study by Briend and others also suggested that dysentery adversely affected linear growth after threemonth lag

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WordScorePoS
study0NN
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growth0.208565600657229NN

Label: 10, with a score of: 0.389401916840986
WordScorePoS
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Studies that started follow up from birth see also the specificity and temporality arguments later have shown with increasing consistency that diarrheal episodes lead to irreversible growth faltering

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WordScorePoS
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The Gambia study Campbell Elia and Lunn concluded that the lack of association between diarrheal disease and long term growth as described by Briend et al

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WordScorePoS
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growth0.208565600657229NN

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Label: 17, with a score of: 0.333055277193563
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Label: 10, with a score of: 0.336611971514842
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does not preclude the possibility of the presence of growth retarding gastrointestinal enteropathy

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WordScorePoS
growth0.208565600657229NN

Label: 10, with a score of: 0.456331861301254
WordScorePoS
growth0.11178243319132NN

Hence when the gut of young infants is damaged from malabsorption disease growth faltering will result even in the absence of diarrheal symptoms and may not be attributed to the diarrheal episodes

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WordScorePoS
infant0NN
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Label: 8, with a score of: 0.553112846555902
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infant0NN
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Label: 6, with a score of: 0.454981887219943
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infant0NN
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Investigators have already questioned how children in the Bangladesh study Briend and others could have caught up in growth despite the extra nutritional requirements generated by this common malabsorption disease Lunn Northrop Clewes and Downes

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WordScorePoS
child0.10682408961305NN
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WordScorePoS
child0.0452169560888236NN
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There are few follow up data concerning helminths

Label: 17, with a score of: 0.851744941703599
WordScorePoS
datum0.0739231123597559NN

Label: 9, with a score of: 0.523956633971108
WordScorePoS
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One study from northeastern Brazilian shantytown where subjects were followed from birth to seven years of age showed that helminths independently and additively caused

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WordScorePoS
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Label: 1, with a score of: 0.459364486540305
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centimeters of growth faltering on average

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growth0.11178243319132NN
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Label: 8, with a score of: 0.554035596489963
WordScorePoS
growth0.208565600657229NN
average0NN

Label: 13, with a score of: 0.440015658242209
WordScorePoS
growth0NN
average0.1656430212089NN

This result was on top of the effects of diarrhea Moore and others and is consistent with an early quasi experimental study from rural St

Label: 2, with a score of: 0.818842056107887
WordScorePoS
result0NN
effect0.0440683498519077NN
consistent0JJ
study0NN
rural0.148975141598503JJ
st0IN

Lucia West Indies

Label: 0, with a score of: 1

That study revealed that the introduction of household connections and latrines resulted in lower levels of Ascaris and Trichuris lower diarrhea prevalence rates and improved growth in infanthood Henry

Label: 8, with a score of: 0.509744979928885
WordScorePoS
study0NN
introduction0NN
household0NN
latrine0NN
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level0.00761994916892276NN
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improve0.0150723186962745VB
growth0.208565600657229NN

Label: 6, with a score of: 0.428341260665161
WordScorePoS
study0NN
introduction0NN
household0NN
latrine0.0683326727248364NN
result0.0683326727248364NN
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prevalence0NN
rate0NN
improve0.0511916925627245VB
growth0NN

Label: 10, with a score of: 0.383874301033856
WordScorePoS
study0NN
introduction0NN
household0.0330412182586772NN
latrine0NN
result0NN
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prevalence0NN
rate0.0172128079963482NN
improve0.0121171980355011VB
growth0.11178243319132NN

Specificity Dose Response Researchers have shown dose response relationships between infections and growth faltering in several ways that closely relate to the specificity criteria

Label: 8, with a score of: 0.684875981174759
WordScorePoS
response0NN
researcher0NN
infection0NN
growth0.208565600657229NN
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Four studies Adair and others Brush Harrison and Waterlow Checkley and others Moore and others have demonstrated that diarrheal TECHNICAL REVIEW OF COHORT STUDIES episodes the dose with increasing period prevalence show lagged or lasting effects in terms of growth faltering the response

Label: 8, with a score of: 0.527131177854583
WordScorePoS
study0NN
technical0.0410992516792148JJ
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increase0.00711043475673939NN
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prevalence0NN
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term0NN
growth0.208565600657229NN
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Label: 17, with a score of: 0.492716868364836
WordScorePoS
study0NN
technical0JJ
review0.036961556179878NN
increase0.00432344066632653NN
period0NN
prevalence0NN
last0.048933054487825JJ
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growth0NN
response0NN

This finding is consistent with many older studies that performed regression analyses for effects that did not lag Baumgartner and Pollitt Black Brown and Becker Lutter and others Martorell Yarbrough and others Rowland Cole and Whitehead Zumrawi Dimond and Waterlow

Label: 0, with a score of: 1

Several studies have demonstrated dose response effects relating the nature of infection bouts to growth faltering the more severe the infection bouts the more significant the growth faltering effects in children

Label: 8, with a score of: 0.607012499421024
WordScorePoS
study0NN
response0NN
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child0.0452169560888236NN

Label: 12, with a score of: 0.2136806759572
WordScorePoS
study0NN
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effect0NN
nature0.162755901889551NN
infection0NN
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child0NN

Label: 3, with a score of: 0.477929379874058
WordScorePoS
study0NN
response0NN
effect0NN
nature0NN
infection0.122222546933424NN
growth0NN
significant0.0127591822694525JJ
child0.10682408961305NN

Especially in the case of invasive infections such as enterotoxigenic E

Label: 3, with a score of: 0.920901128500715
WordScorePoS
invasive0JJ
infection0.122222546933424NN

Label: 15, with a score of: 0.389796243601846
WordScorePoS
invasive0.0517339898971162JJ
infection0NN

coli Shigella measles and acute lower respiratory infection significant metabolic or merely dose response effects have been observed Alam and others Black Brown and Becker Briend and others Chisti and others Henry and others Victora and others Villamor and others as expected by Powanda and Beisel and Scrimshaw Taylor and Gordon

Label: 0, with a score of: 1

Even the study that has most strongly challenged the irreversible effects of infections on growth makes an exemption with respect to dysentery Briend and others

Label: 8, with a score of: 0.681699424481912
WordScorePoS
study0NN
challenge0.0347609334428716NN
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infection0NN
growth0.208565600657229NN
respect0NN

Label: 3, with a score of: 0.4122967361363
WordScorePoS
study0NN
challenge0NN
effect0NN
infection0.122222546933424NN
growth0NN
respect0.0249430985430622NN

Label: 10, with a score of: 0.313167738387143
WordScorePoS
study0NN
challenge0NN
effect0NN
infection0NN
growth0.11178243319132NN
respect0NN

Also infections for example protozoa pose special immunological challenges in early preweaning infancy Marodi Wilson appear to contribute to permanent growth faltering Checkley and others Molbak and others

Label: 8, with a score of: 0.616443120931342
WordScorePoS
infection0NN
pose0VB
special0JJ
challenge0.0347609334428716NN
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growth0.208565600657229NN

Label: 11, with a score of: 0.429354836434594
WordScorePoS
infection0NN
pose0VB
special0.0747035830159326JJ
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contribute0VB
growth0NN

Prado and others show that among Giardia infected children the more time the child remained untreated during the follow up period the more he or she experienced lagged linear growth faltering

Label: 8, with a score of: 0.548951188946991
WordScorePoS
infected0JJ
child0.0452169560888236NN
time0NN
remain0.049270765107907VB
untreated0JJ
period0NN
experienced0JJ
growth0.208565600657229NN

Label: 3, with a score of: 0.421084821336679
WordScorePoS
infected0.0407408489778079JJ
child0.10682408961305NN
time0.0127591822694525NN
remain0VB
untreated0JJ
period0NN
experienced0JJ
growth0NN

Label: 10, with a score of: 0.410839122853443
WordScorePoS
infected0JJ
child0.0242343960710022NN
time0.0607862199751165NN
remain0.0396106020715138VB
untreated0JJ
period0NN
experienced0JJ
growth0.11178243319132NN

Temporality The proposition that the associations between infections and growth faltering are merely transitory has been given importance in several relatively new studies which emphasize that there are lagged or lasting effects that continue until two to seven years of age if the burden of infection began in early infancy Adair and others Checkley and others Maleta and others Moore and others Prado and others

Label: 8, with a score of: 0.498203407192184
WordScorePoS
infection0NN
growth0.208565600657229NN
study0NN
last0JJ
effect0NN
continue0.0295821503613099VB
age0.0252035516550537NN
burden0NN

This interpretation is supported by many earlier as well as more contemporary studies Baumgartner and Pollitt Brush Harrison and Waterlow Checkley and others Chisti and others Fikree Rahbar and Berendes Martorell Habicht and others Martorell Yarbrough and others Molbak and others Morley Bicknell and Woodland Rowland Cole and Whitehead Victora and others

Label: 0, with a score of: 1

As follow up data from Central America indicate the growth status of children at two years of age strongly predicts their height in adulthood Martorell

Label: 8, with a score of: 0.477395422341841
WordScorePoS
datum0NN
central0JJ
growth0.208565600657229NN
status0NN
child0.0452169560888236NN
age0.0252035516550537NN
predict0VB
height0NN

Label: 1, with a score of: 0.565130108176867
WordScorePoS
datum0NN
central0JJ
growth0.0519476926891779NN
status0NN
child0.0450489732120807NN
age0.112994637345193NN
predict0VB
height0.120266261535276NN

Label: 10, with a score of: 0.351046043878573
WordScorePoS
datum0NN
central0JJ
growth0.11178243319132NN
status0.0488696285210061NN
child0.0242343960710022NN
age0.0202620733250388NN
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height0NN

Label: 3, with a score of: 0.335628029551617
WordScorePoS
datum0NN
central0JJ
growth0NN
status0NN
child0.10682408961305NN
age0.0893142758861673NN
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height0NN

The observed lagged or lasting effects are considered irreversible Checkley and others

Label: 0, with a score of: 1

These lagged effects are also important because they reduce the ENVIRONMENTAL HEALTH AND CHILD SURVIVAL possibility of reverse causality that is that malnutrition increased the risk of infection in the first place Prado and others

Label: 3, with a score of: 0.748825462840584
WordScorePoS
effect0NN
reduce0.01675146888405VB
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
reverse0NN
malnutrition0NN
increase0.0143984997539974NN
risk0.0703902516159815NN
infection0.122222546933424NN

Label: 1, with a score of: 0.331851949138891
WordScorePoS
effect0NN
reduce0.0164833460638534VB
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
reverse0NN
malnutrition0.0736315832425121NN
increase0NN
risk0.0519476926891779NN
infection0NN

Biological Plausibility The proposition that infections cause undernutrition is biologically plausible

Label: 3, with a score of: 0.916910675426091
WordScorePoS
biological0JJ
infection0.122222546933424NN

There are many mechanisms both proven anorexia malabsorption loss of nutrients and still hypothetical decreased nutrient transport to periphery that interact with the host immune responses table

Label: 17, with a score of: 0.535462110697206
WordScorePoS
mechanism0.147846224719512NN
loss0NN
nutrient0NN
decrease0NN
transport0.0249900578719309NN
response0NN

Label: 11, with a score of: 0.555901075638166
WordScorePoS
mechanism0NN
loss0.0315914058171786NN
nutrient0NN
decrease0.0731385760866977NN
transport0.0747035830159326NN
response0NN

see also Keusch Scrimshaw Scrimshaw Taylor and Gordon

Label: 0, with a score of: 1

An important but surprisingly little studied mechanism is the acute phase response to infection in children

Label: 17, with a score of: 0.432513253361935
WordScorePoS
study0NN
mechanism0.147846224719512NN
phase0NN
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infection0NN
child0NN

Label: 3, with a score of: 0.670059084242887
WordScorePoS
study0NN
mechanism0NN
phase0NN
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infection0.122222546933424NN
child0.10682408961305NN

Label: 12, with a score of: 0.317420278011402
WordScorePoS
study0NN
mechanism0NN
phase0.108503934593034NN
response0NN
infection0NN
child0NN

The withholding of food because of anorexia in the acute phase of an infection such as diarrhea appears initially to have some beneficial effects

Label: 2, with a score of: 0.714027517871527
WordScorePoS
food0.292342270824999NN
phase0NN
infection0NN
effect0.0440683498519077NN

Label: 12, with a score of: 0.626983682751963
WordScorePoS
food0.186896403054502NN
phase0.108503934593034NN
infection0NN
effect0NN

However long lasting anorexia delays recovery and is ultimately deleterious to child health Langhans

Label: 3, with a score of: 0.774821310787004
WordScorePoS
last0JJ
recovery0NN
ultimately0RB
child0.10682408961305NN
health0.191387734041787NN

Label: 16, with a score of: 0.436206084959279
WordScorePoS
last0JJ
recovery0.107490825192354NN
ultimately0RB
child0.0603953832457135NN
health0NN

This mechanism probably underlies widespread traditional cultural practices relating to the deliberate restriction of food intake in children during disease episodes

Label: 2, with a score of: 0.66301702904408
WordScorePoS
mechanism0NN
underlie0VB
traditional0.0440683498519077JJ
cultural0JJ
practice0.0252000451111224NN
restriction0.0583416713841148NN
food0.292342270824999NN
intake0NN
child0.0546336178945768NN
disease0NN

Label: 3, with a score of: 0.45018195952127
WordScorePoS
mechanism0NN
underlie0VB
traditional0JJ
cultural0JJ
practice0NN
restriction0NN
food0NN
intake0NN
child0.10682408961305NN
disease0.215415047323213NN

Label: 12, with a score of: 0.359315333344762
WordScorePoS
mechanism0NN
underlie0VB
traditional0JJ
cultural0JJ
practice0.0703006268489394NN
restriction0NN
food0.186896403054502NN
intake0NN
child0NN
disease0NN

Label: 17, with a score of: 0.20654754659803
WordScorePoS
mechanism0.147846224719512NN
underlie0VB
traditional0JJ
cultural0JJ
practice0NN
restriction0NN
food0NN
intake0NN
child0NN
disease0NN

It was only in that continued feeding during diarrhea was included as an important component of diarrheal patient management in the American Academy of Pediatrics Pediatric Nutrition Handbook Brown

Label: 2, with a score of: 0.707110320421378
WordScorePoS
continue0VB
include0VB
management0NN
nutrition0.175025014152344NN

Experimental Evidence from Deworming Deworming with anthelminthics is often safe and highly effective in reducing or eliminating such soil transmitted helminths as roundworm Ascaris lumbricoides hookworm Necator americanus or Ancylostoma duodenale or whipworm Trichuris trichiuria Awasthi and Bundy Dickson and others

Label: 10, with a score of: 0.690855492795495
WordScorePoS
evidence0.12939607756667NN
safe0.0202620733250388JJ
highly0RB
effective0.0145231653596925JJ
reduce0.0310356414389692VB
eliminate0.0558912165956601VB
soil0NN

WHO recommends the widespread use of anthelminthics among children in an effort to cut transmission that occurs in tropical countries Awasthi and Bundy

Label: 3, with a score of: 0.705950447750042
WordScorePoS
recommend0.0407408489778079VB
child0.10682408961305NN
effort0.0127591822694525NN
cut0NN
occur0.0307735781890304VB
tropical0.0407408489778079JJ
country0NN

Label: 1, with a score of: 0.503386365136022
WordScorePoS
recommend0VB
child0.0450489732120807NN
effort0NN
cut0.120266261535276NN
occur0VB
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More and more in large areas of developing countries almost all children especially after weaning are being infected Awasthi Bundy and Savioli

Label: 3, with a score of: 0.732423443806032
WordScorePoS
develop0VB
country0NN
child0.10682408961305NN
infected0.0407408489778079JJ

Trials carried out in the late th century that tried to establish the effectiveness of anthelminthics in improving nutritional status were conducted largely on schoolchildren infected with roundworm

Label: 13, with a score of: 0.754368237007831
WordScorePoS
century0.219293228426234NN
establish0VB
improve0.0102677744436108VB
nutritional0JJ
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conduct0NN
infected0JJ

The trials showed that despite methodological problems single anthelminthic dose may lead to significant weight gain of

Label: 0, with a score of: 1

kilograms percent confidence interval

Label: 0, with a score of: 1

kilograms fixed effect model to

Label: 9, with a score of: 0.718120873858835
WordScorePoS
effect0.0454743001434393NN

Label: 2, with a score of: 0.695918393583776
WordScorePoS
effect0.0440683498519077NN

kilograms percent confidence interval

Label: 0, with a score of: 1

kilograms random effect model over period of one year or more Dickson and others

Label: 2, with a score of: 0.82133334435166
WordScorePoS
effect0.0440683498519077NN
period0.0440683498519077NN

Subsequent rapid reinfection often masks the beneficial effects of deworming on weight gain

Label: 0, with a score of: 1

recent comprehensive meta analysis of randomized trials supports the idea that single dose of deworming drug has significant effect on the mean change TECHNICAL REVIEW OF COHORT STUDIES in weight in children who have an initial high worm prevalence or intensity compared with no effect in group with low worm prevalence or intensity TaylorRobinson Jones and Garner

Label: 13, with a score of: 0.573660391323336
WordScorePoS
support0NN
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significant0.0343390275626203JJ
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compare0.0414107553022249VB

Conclusions Consistent and biologically plausible results from the reviewed cohort studies coupled with evidence of specificity reveal how increments in infection load number severity and duration of episodes are associated with stronger effects on nutrition which appear after time lag in terms of stunting

Label: 2, with a score of: 0.648549796254575
WordScorePoS
conclusion0NN
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effect0.0440683498519077NN
nutrition0.175025014152344NN
time0.0182713919265625NN
term0NN
stunt0.11668334276823NN

Label: 17, with a score of: 0.499442920644891
WordScorePoS
conclusion0.048933054487825NN
consistent0.036961556179878JJ
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review0.036961556179878NN
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evidence0NN
infection0NN
effect0NN
nutrition0NN
time0NN
term0.149793392961411NN
stunt0NN

Label: 10, with a score of: 0.420937547108924
WordScorePoS
conclusion0NN
consistent0JJ
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evidence0.12939607756667NN
infection0NN
effect0NN
nutrition0NN
time0.0607862199751165NN
term0.0396106020715138NN
stunt0NN

The results support the idea that infections especially if acquired in early infancy cause irreversible and often highly prevalent undernutrition among children under five years of age in developing countries

Label: 3, with a score of: 0.721814809892628
WordScorePoS
result0NN
support0.00625975725959118NN
idea0NN
infection0.122222546933424NN
acquire0.0307735781890304NN
highly0RB
child0.10682408961305NN
age0.0893142758861673NN
develop0VB
country0NN

Label: 1, with a score of: 0.35852131284191
WordScorePoS
result0NN
support0.0184786920895884NN
idea0NN
infection0NN
acquire0NN
highly0RB
child0.0450489732120807NN
age0.112994637345193NN
develop0VB
country0NN

Label: 4, with a score of: 0.331908260694504
WordScorePoS
result0NN
support0NN
idea0NN
infection0NN
acquire0.0615662203253227NN
highly0RB
child0.076326555629389NN
age0.0255262687343935NN
develop0VB
country0NN

Experimental anthelminthic trials on humans also support the idea that soil transmitted helminths and other pathogens associated with similar pathophysiological effects malabsorption and loss of nutrients cause undernutrition

Label: 0, with a score of: 1

In summary several strong masking elements are important in estimating how much of undernutrition is attributable to infections

Label: 3, with a score of: 0.886913408159435
WordScorePoS
strong0JJ
estimate0.059903311017139NN
infection0.122222546933424NN

Enteric infections cause growth faltering in children in developing countries even in the absence of diarrhea

Label: 8, with a score of: 0.62859630561876
WordScorePoS
infection0NN
growth0.208565600657229NN
child0.0452169560888236NN
develop0VB
country0NN

Label: 3, with a score of: 0.567327681593135
WordScorePoS
infection0.122222546933424NN
growth0NN
child0.10682408961305NN
develop0VB
country0NN

Label: 10, with a score of: 0.336901312180524
WordScorePoS
infection0NN
growth0.11178243319132NN
child0.0242343960710022NN
develop0VB
country0NN

These infections make children with diarrhea and without diarrhea appear to be more alike with respect to growth

Label: 8, with a score of: 0.603100514998393
WordScorePoS
infection0NN
child0.0452169560888236NN
respect0NN
growth0.208565600657229NN

Label: 3, with a score of: 0.603592863122131
WordScorePoS
infection0.122222546933424NN
child0.10682408961305NN
respect0.0249430985430622NN
growth0NN

Label: 10, with a score of: 0.323236635442365
WordScorePoS
infection0NN
child0.0242343960710022NN
respect0NN
growth0.11178243319132NN

In some studies there is relatively high disease burden in the control group which again makes children with and without infections more alike

Label: 3, with a score of: 0.881594629101471
WordScorePoS
study0NN
disease0.215415047323213NN
burden0NN
control0.020806307400253NN
child0.10682408961305NN
infection0.122222546933424NN

The active case management and supporting nutritional therapies including breastfeeding that are often targeted at study participants mitigate the effects of infections on nutritional status

Label: 17, with a score of: 0.544841744672931
WordScorePoS
active0.048933054487825JJ
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support0.0451108483130998NN
nutritional0JJ
therapy0NN
include0VB
target0.0898760357768464NN
study0NN
effect0NN
infection0NN
status0.036961556179878NN

Label: 3, with a score of: 0.448890357473011
WordScorePoS
active0JJ
management0.0127591822694525NN
support0.00625975725959118NN
nutritional0JJ
therapy0.0407408489778079NN
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target0NN
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infection0.122222546933424NN
status0NN

Not enough infants are enrolled in many of these cohort studies therefore the studies miss the long lasting effects in the most vulnerable period to months on nutritional status

Label: 2, with a score of: 0.674412716259614
WordScorePoS
infant0.0583416713841148NN
enrol0VB
study0NN
last0JJ
effect0.0440683498519077NN
vulnerable0.0182713919265625JJ
period0.0440683498519077NN
nutritional0.0583416713841148JJ
status0NN

Environmentally attributable growth faltering especially malaria and hookworms during the fetal period that manifests itself in intrauterine growth retardation is not adequately captured in these studies

Label: 8, with a score of: 0.761214433296933
WordScorePoS
environmentally0RB
growth0.208565600657229NN
malaria0NN
period0NN
capture0NN
study0NN

Label: 3, with a score of: 0.371735825190632
WordScorePoS
environmentally0RB
growth0NN
malaria0.20370424488904NN
period0NN
capture0NN
study0NN

Independent of this review group of experts chosen by WHO Prüss Üstün and Corvalán estimated on the basis of converging expert opinion using the Delphi method that percent with confidence interval of to percent of the consequences of maternal and childhood underweight are attributable to environmental issues especially to poor water sanitation and hygiene

Label: 6, with a score of: 0.885471471409347
WordScorePoS
review0NN
estimate0NN
basis0NN
maternal0JJ
childhood0NN
environmental0JJ
issue0NN
poor0.0642010940957526JJ
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN

Label: 3, with a score of: 0.269792980772572
WordScorePoS
review0NN
estimate0.059903311017139NN
basis0NN
maternal0.184641469134183JJ
childhood0NN
environmental0JJ
issue0.0249430985430622NN
poor0JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN

Label: 12, with a score of: 0.243794287082502
WordScorePoS
review0NN
estimate0.0199423462679015NN
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maternal0JJ
childhood0NN
environmental0.0598270388037045JJ
issue0NN
poor0.0339811641917276JJ
water0.186896403054502NN
sanitation0NN
hygiene0NN

Label: 1, with a score of: 0.158018163277581
WordScorePoS
review0NN
estimate0NN
basis0NN
maternal0JJ
childhood0NN
environmental0.0442083771593746JJ
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poor0.150659516460257JJ
water0NN
sanitation0NN
hygiene0NN

Fewtrell and others use this attributable fraction in estimating the regional burden of disease from poor water resources management including lack of water sanitation and hygiene

Label: 6, with a score of: 0.898902761121117
WordScorePoS
estimate0NN
regional0JJ
burden0NN
disease0.103230094596636NN
poor0.0642010940957526JJ
water0.556409482163189NN
resource0.0104991907358033NN
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include0VB
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The regional estimates of disease burden presented in chapter are based on those two studies

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL For reasons such as heterogeneous inclusion criteria and analysis techniques and differing follow up times masking effects and the like it is virtually impossible to assess the literature systematically to find out how much what percentage of growth faltering is attributable to diarrheal episodes

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Furthermore not all studies present their results hence the variance of growth faltering that is explainable by infections is not readily available

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It is important to note that because the prevention of infections more than proportionately moves children from severe to moderate and mild malnutrition state see table D

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far less than percent of weight gain attributed to environmental infections explains percent of the consequences of maternal and childhood underweight

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The idea that substantial proportion of children with severe undernutrition can be lifted to the moderate and mild categories is also supported by experimental data on humans Ahmed and others

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Findings from this review of cohort studies support the percent figure used by WHO in its reports

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Examples of cohort studies from this review provide some idea of how experts have come up with this figure

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For example recent relatively large study in Bangladesh reveals that dysentery and watery diarrhea together could retard weight gain by to percent compared with the results in periods when no infections occurred Alam and others

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The weight gain retardation is likely to be significantly higher when compared with international standards

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Simulations that use weight gain retardation of percent result in environmentally attributable health burdens that are approximately similar to the point estimate from WHO experts

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Choice of Parameters The results of the review informed the choice of parameters used in this study to estimate the revised costs of environmental infections through malnutrition

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The literature reviewed shows that diarrhea and other infections cause weight gain retardation of to percent

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Limited research studies how the retardation factor may vary with score and age

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This study assumes an average loss of percent in terms of weight gain see table D

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and step in appendix as attributable to infections in early childhood in developing countries

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This percentage is used in studies in Ghana and Pakistan to compute counterfactual underweight scores and prevalence rates in order to estimate deaths in children under five years of age attributable to infections and malnutrition presented in chapter

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For estimating the effect of stunting on educational performance this study assumes an average loss of percent in height gain from diarrheal infections in early childhood

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The literature reviewed in this appendix suggests that the effect on stunting is somewhat less than on weight gain see table D

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and step in appendix

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TECHNICAL REVIEW OF COHORT STUDIES Notes Breastfeeding not only diminishes transmission by various mechanisms but also substantially supports energy balance during disease bouts Brown

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Briend and others observed that the effects of dysentery did not become visible until three months had elapsed

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World Health Assembly resolution

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passed in May

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Recent expert opinion Prüss Üstün and Corvalán suggests that percent of the health burden attributable to maternal and childhood underweight results from rampant diarrheal disease

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TABLE A

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Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries Country study Number of Setting Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Group was characterized by lower birthweights diarrheal bouts before months and measles and pertussis bouts at months marked distinction between the groups in weight remained until children were years old

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Nigeria Morley Bicknell and Woodland Rural months Up to years Monthly Symptom of diarrhea weights accepted only when clinical examination confirmed diagnosis and illness was considered of sufficient severity to warrant specific treatment Age child whose weight fell below the percentile at or months was selected to group the undernourished group child who remained between the th and th percentile at or months was selected to group B

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Guatemala Martorell Habicht and others Martorell Yarbrough and others Rural months Retrospective disease reporting every weeks Every months Used low versus high Age sex dietary Children were diarrhea groups Used supplement subject to linear regression

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supplemental nutrition

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Found on average

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centimeter length and

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kilogram weight relative difference Martorell Yarbrough and others regression techniques revealed doseresponse and of growth deficits would be explainable by diarrhea

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Gambia Rowland Cole and Whitehead Rural months to On less than average weeks years Self reported period prevalence percentage of sick days of disease between clinic visits weeks diarrhea period prevalence During clinic visits to week intervals Period prevalence was regressed with height and weight gain

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Mean difference between and period prevalence of diarrhea in height and weight gain was

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millimeters and grams per month regression techniques revealed doseresponse

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months Age season In groups and and children died respectively

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Effect of Disease on Malnutrition Treatment was encouraged and facilitated

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Country study Number of Setting Children Mexico CondonPaoloni and others Rural months years Retrospective probing of disease by health worker every second week to establish period prevalence Monthly but weight measured every weeks Mean growth in upper and lower diarrhea quartiles were compared in factorial design

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St

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Lucia West Rural Indies Henry Less than months up to months Examination of stools every months for Ascaris and Trichuris mothers instructed to fill out diarrhea cards Monthly months More than years study participants of which subjects were used to study effects on nutrition years months Taiwan China Baumgartner and Pollitt Rural Northeastern Small Brazil Guerrant town plus and others rural adjacent areas with varying Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition Age sex growth failure children who developed clinical protein calorie malnutrition were excluded Diarrhea was the only infection associated with decreased weight gain and high diarrhea group attained of the weight of the low diarrhea group height was not affected by diarrhea

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disease0.215415047323213NN
malnutrition0NN
sex0NN
growth0NN
child0.10682408961305NN
develop0VB
protein0NN
infection0.122222546933424NN
decrease0NN
gain0NN
attain0VB
height0NN
affect0.00625975725959118VB

Label: 8, with a score of: 0.191645717636337
WordScorePoS
rural0JJ
mother0NN
study0NN
effect0NN
nutrition0NN
age0.0252035516550537NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0295821503613099NN
control0NN
disease0NN
malnutrition0NN
sex0NN
growth0.208565600657229NN
child0.0452169560888236NN
develop0VB
protein0NN
infection0NN
decrease0NN
gain0NN
attain0VB
height0NN
affect0VB

Quasiexperimental community trial testing took place in factorial design of the effectiveness of household water connections and water seal latrines to prevent helminths

Label: 6, with a score of: 0.920002903615045
WordScorePoS
community0.0214003646985842NN
household0NN
water0.556409482163189NN
latrine0.0683326727248364NN
prevent0VB

Label: 12, with a score of: 0.341358898863232
WordScorePoS
community0.0169905820958638NN
household0.0554128417527413NN
water0.186896403054502NN
latrine0NN
prevent0VB

Comparability by design for confounders food intake socioeconomic conditions general household conditions Ascaris infected children were actively treated with piperazine phosphate

Label: 2, with a score of: 0.610763139510646
WordScorePoS
food0.292342270824999NN
intake0NN
condition0NN
household0.0297950283197006NN
infected0JJ
child0.0546336178945768NN

Label: 12, with a score of: 0.525652879784202
WordScorePoS
food0.186896403054502NN
intake0NN
condition0.0409791940864438NN
household0.0554128417527413NN
infected0JJ
child0NN

Label: 8, with a score of: 0.467458592646882
WordScorePoS
food0NN
intake0NN
condition0.121575732851624NN
household0NN
infected0JJ
child0.0452169560888236NN

In the nonintervention village children remained shorter and weighed less and had helminths diarrhea and other water washed disease more often than in the village where both household connection and sanitation were provided when interventions were introduced they led to catch up growth

Label: 6, with a score of: 0.812971181921301
WordScorePoS
child0.0255958462813622NN
remain0VB
water0.556409482163189NN
disease0.103230094596636NN
household0NN
sanitation0.334686906581616NN
intervention0NN
introduce0VB
lead0NN
growth0NN

Label: 3, with a score of: 0.360061266676274
WordScorePoS
child0.10682408961305NN
remain0VB
water0.0382775468083574NN
disease0.215415047323213NN
household0NN
sanitation0.0249430985430622NN
intervention0.0407408489778079NN
introduce0VB
lead0.025518364538905NN
growth0NN

Label: 8, with a score of: 0.281740218114755
WordScorePoS
child0.0452169560888236NN
remain0.049270765107907VB
water0NN
disease0NN
household0NN
sanitation0NN
intervention0NN
introduce0VB
lead0.0504071033101074NN
growth0.208565600657229NN

Label: 12, with a score of: 0.206685627549079
WordScorePoS
child0NN
remain0VB
water0.186896403054502NN
disease0NN
household0.0554128417527413NN
sanitation0NN
intervention0NN
introduce0VB
lead0.0169905820958638NN
growth0NN

Daily collection by nurses Monthly or to record frequency bimonthly duration and total days per symptom Twelve disease categories were regressed with growth

Label: 1, with a score of: 0.59824080773752
WordScorePoS
daily0RB
collection0NN
record0NN
total0NN
day0.25973846344589NN
disease0NN
growth0.0519476926891779NN

Label: 8, with a score of: 0.467033454770877
WordScorePoS
daily0RB
collection0NN
record0NN
total0NN
day0.0347609334428716NN
disease0NN
growth0.208565600657229NN

Label: 3, with a score of: 0.44723722697182
WordScorePoS
daily0RB
collection0NN
record0NN
total0NN
day0.0175975629039954NN
disease0.215415047323213NN
growth0NN

Label: 6, with a score of: 0.311439133548048
WordScorePoS
daily0RB
collection0NN
record0NN
total0.0295155485671997NN
day0.0295155485671997NN
disease0.103230094596636NN
growth0NN

Nutritional treatment treatment timing sex Nutritional supplementation kilocalories was provided in placebocontrolled trial

Label: 0, with a score of: 1

Negative effect of diarrhea on growth rate was the most important finding though it explained only of variance regression techniques revealed dose response

Label: 8, with a score of: 0.673995414670305
WordScorePoS
effect0NN
growth0.208565600657229NN
rate0NN
response0NN

Daily diary by mother or legal guardian plus weekly visits by surveillance team recording clinical symptoms to establish period prevalence Regression analysis of child periods of months were regressed against the number of diarrhea episodes Age breastfeeding growth status before the period Antidiarrheal treatments iodochlorhydroxyquin and kaolin pectin were given

Label: 3, with a score of: 0.633688699648557
WordScorePoS
daily0RB
mother0.162963395911232NN
legal0JJ
record0NN
establish0VB
period0NN
prevalence0.0407408489778079NN
child0.10682408961305NN
age0.0893142758861673NN
growth0NN
status0NN
treatment0.0624189222007589NN

Label: 8, with a score of: 0.382446584431433
WordScorePoS
daily0RB
mother0NN
legal0JJ
record0NN
establish0VB
period0NN
prevalence0NN
child0.0452169560888236NN
age0.0252035516550537NN
growth0.208565600657229NN
status0NN
treatment0NN

Multiple different pathogens were found in of episodes and height faltering attributable to episodes was especially pronounced during the second year of life Breastfeeding found to be highly Quarterly height weekly weight continued TABLE A

Label: 0, with a score of: 1

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank protective especially in first weeks

Label: 3, with a score of: 0.581754409536296
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN

Label: 1, with a score of: 0.450348787144164
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0450489732120807NN
develop0VB
country0NN
continue0VB
set0NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN

Regression techniques revealed dose response

Label: 13, with a score of: 1
WordScorePoS
response0.0548233071065585NN

collection of stool specimens by health worker levels of environmental health services Effect of Disease on Malnutrition Bangladesh Black Brown and Becker Rural months months Period prevalence of diarrhea within day periods as actively established by health worker who visited homes every days Monthly Growth in zeroperiod prevalence periods was compared with growth in nonzero periods

Label: 3, with a score of: 0.536787253304224
WordScorePoS
collection0NN
health0.191387734041787NN
worker0NN
level0NN
environmental0JJ
service0.0100171139310145NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
rural0JJ
period0NN
prevalence0.0407408489778079NN
day0.0175975629039954NN
establish0VB
home0NN
growth0NN
compare0.0307735781890304VB

Label: 1, with a score of: 0.50320568415204
WordScorePoS
collection0NN
health0NN
worker0NN
level0.0113874611101829NN
environmental0.0442083771593746JJ
service0.0443555132287109NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
rural0JJ
period0NN
prevalence0NN
day0.25973846344589NN
establish0VB
home0.0908430554521382NN
growth0.0519476926891779NN
compare0VB

Label: 8, with a score of: 0.445956095368851
WordScorePoS
collection0NN
health0NN
worker0.121575732851624NN
level0.00761994916892276NN
environmental0.0295821503613099JJ
service0.0197870712294258NN
effect0NN
disease0NN
malnutrition0NN
rural0JJ
period0NN
prevalence0NN
day0.0347609334428716NN
establish0VB
home0NN
growth0.208565600657229NN
compare0VB

Label: 2, with a score of: 0.269403607251583
WordScorePoS
collection0NN
health0NN
worker0NN
level0.00552410547653725NN
environmental0JJ
service0.0143446978608332NN
effect0.0440683498519077NN
disease0NN
malnutrition0.0357189919948307NN
rural0.148975141598503JJ
period0.0440683498519077NN
prevalence0NN
day0NN
establish0VB
home0NN
growth0.0252000451111224NN
compare0VB

Bangladesh Henry and others Rural villages On average children months months Period day prevalence and attack rates based on weekly visits by health assistants Five anthropometric surveys every months Mean duration of Age watery diarrhea and dysentery in different anthropometric categories were tabulated

Label: 1, with a score of: 0.567346969425987
WordScorePoS
rural0JJ
average0NN
child0.0450489732120807NN
period0NN
day0.25973846344589NN
prevalence0NN
rate0.0639932865717261NN
base0.0442083771593746NN
health0NN
survey0NN
age0.112994637345193NN

Label: 3, with a score of: 0.543846373170493
WordScorePoS
rural0JJ
average0NN
child0.10682408961305NN
period0NN
day0.0175975629039954NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
base0.0149758277542848NN
health0.191387734041787NN
survey0NN
age0.0893142758861673NN

Label: 10, with a score of: 0.373836655755525
WordScorePoS
rural0.0330412182586772JJ
average0.146608885563018NN
child0.0242343960710022NN
period0NN
day0NN
prevalence0NN
rate0.0172128079963482NN
base0NN
health0.0405241466500776NN
survey0.064698038783335NN
age0.0202620733250388NN

Label: 2, with a score of: 0.323313205642578
WordScorePoS
rural0.148975141598503JJ
average0NN
child0.0546336178945768NN
period0.0440683498519077NN
day0NN
prevalence0NN
rate0.0155217067874935NN
base0NN
health0NN
survey0NN
age0.0365427838531249NN

Label: 13, with a score of: 0.178669147632303
WordScorePoS
rural0JJ
average0.1656430212089NN
child0NN
period0NN
day0NN
prevalence0NN
rate0NN
base0NN
health0NN
survey0NN
age0NN

Bangladesh Bairagi and others rural villages in Matlab Approxi mately years months Weekly visits by field workers to probe day recall diarrhea episodes and duration no distinction between watery diarrhea and dysentery Bimonthly Multiple regression analysis was used to investigate diarrheanutrition relationship

Label: 1, with a score of: 0.673568421645512
WordScorePoS
rural0JJ
field0NN
worker0NN
day0.25973846344589NN
recall0NN
multiple0JJ

Label: 2, with a score of: 0.537625643305505
WordScorePoS
rural0.148975141598503JJ
field0.0583416713841148NN
worker0NN
day0NN
recall0NN
multiple0JJ

Age weight and length at base line Age dwelling floor space proxy for socioeconomic status mother education All cases of diarrhea were medically treated

Label: 3, with a score of: 0.547998732635212
WordScorePoS
age0.0893142758861673NN
base0.0149758277542848NN
line0NN
floor0NN
space0NN
status0NN
mother0.162963395911232NN
education0.0152605842304358NN

Label: 4, with a score of: 0.435207966329634
WordScorePoS
age0.0255262687343935NN
base0NN
line0NN
floor0NN
space0NN
status0NN
mother0NN
education0.244244978014045NN

Label: 1, with a score of: 0.608660189314378
WordScorePoS
age0.112994637345193NN
base0.0442083771593746NN
line0NN
floor0.120266261535276NN
space0NN
status0NN
mother0NN
education0.0225244866060403NN

Children with no diarrhea gain on average

Label: 10, with a score of: 0.542895300731318
WordScorePoS
child0.0242343960710022NN
gain0NN
average0.146608885563018NN

Label: 13, with a score of: 0.526370232139947
WordScorePoS
child0NN
gain0NN
average0.1656430212089NN

Label: 3, with a score of: 0.339459039308676
WordScorePoS
child0.10682408961305NN
gain0NN
average0NN

centimeter more in length per year compared with children suffering from diarrhea diarrhea also adversely affected weight gain invasive Shigella and enterotoxigenic E

Label: 3, with a score of: 0.449430230982949
WordScorePoS
compare0.0307735781890304VB
child0.10682408961305NN
suffer0VB
affect0.00625975725959118VB
gain0NN
invasive0JJ

coli might especially cause irreversible growth faltering regression techniques revealed doseresponse

Label: 8, with a score of: 0.851431893492884
WordScorePoS
growth0.208565600657229NN

Label: 10, with a score of: 0.456331861301254
WordScorePoS
growth0.11178243319132NN

No association of watery diarrhea with growth faltering was noted but stunting was associated with dysentery

Label: 8, with a score of: 0.73970321255045
WordScorePoS
growth0.208565600657229NN
stunt0NN

Label: 2, with a score of: 0.503206652924433
WordScorePoS
growth0.0252000451111224NN
stunt0.11668334276823NN

Label: 10, with a score of: 0.396449964317064
WordScorePoS
growth0.11178243319132NN
stunt0NN

Several observational epidemiological studies led by International Centre for Diarrhoeal Disease Research were carried out in Matlab region

Label: 3, with a score of: 0.746327143448765
WordScorePoS
study0NN
lead0.025518364538905NN
international0JJ
centre0NN
diarrhoeal0NN
disease0.215415047323213NN
research0.0175975629039954NN
region0.124837844401518NN

Label: 1, with a score of: 0.369052311965863
WordScorePoS
study0NN
lead0NN
international0.00531301439641424JJ
centre0NN
diarrhoeal0NN
disease0NN
research0NN
region0.184259548107002NN

Label: 6, with a score of: 0.339868321367333
WordScorePoS
study0NN
lead0NN
international0.00301873916506525JJ
centre0NN
diarrhoeal0.0683326727248364NN
disease0.103230094596636NN
research0NN
region0NN

Those with greater than diarrhea period prevalence had weight and height growth velocity throughout the follow up period compared with those who did not have diarrhea catch up growth among those who had less than diarrhea period prevalence prevented growth faltering

Label: 8, with a score of: 0.758257001991154
WordScorePoS
period0NN
prevalence0NN
height0NN
growth0.208565600657229NN
compare0VB
prevent0VB

Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Sudan Zumrawi Dimond and Waterlow Urban months but falling to due to drop outs and families moving away year Morbidity probed at visits every weeks visits on the basis of day recall period prevalence Every weeks Age Number of days ill were regressed with weight gain weight loss due to infections were externally WHO reference and internally between quartiles assessed Gambia Rowland Rowland and Cole Urban months months Number of illness days categories probed month retrospectively during every clinic visit to establish period prevalence Monthly Illness growth periods were compared with noillness periods

Label: 1, with a score of: 0.683014817699328
WordScorePoS
country0NN
study0NN
set0NN
child0.0450489732120807NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN
urban0JJ
fall0NN
due0.0519476926891779JJ
family0NN
move0NN
basis0NN
day0.25973846344589NN
recall0NN
prevalence0NN
gain0NN
loss0NN
infection0NN
illness0NN
establish0VB
growth0.0519476926891779NN
compare0VB

Label: 11, with a score of: 0.312995127844554
WordScorePoS
country0NN
study0NN
set0NN
child0.0273960270556257NN
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
urban0.27622591898666JJ
fall0NN
due0JJ
family0NN
move0NN
basis0NN
day0NN
recall0NN
prevalence0NN
gain0.04477822029736NN
loss0.0315914058171786NN
infection0NN
illness0NN
establish0VB
growth0NN
compare0VB

Label: 8, with a score of: 0.208938287601035
WordScorePoS
country0NN
study0NN
set0NN
child0.0452169560888236NN
age0.0252035516550537NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0295821503613099NN
control0NN
urban0JJ
fall0NN
due0JJ
family0NN
move0NN
basis0NN
day0.0347609334428716NN
recall0NN
prevalence0NN
gain0NN
loss0NN
infection0NN
illness0NN
establish0VB
growth0.208565600657229NN
compare0VB

Bangladesh Briend and others Rural On average months months fourteen quarterly rounds Height and weight measured quarterly diarrhea morbidity collected by means of weekly recall by the children mothers Quarterly varying Growth rates of diarrhea free periods were compared with growth rates of periods with varying prevalence of diarrhea with attention to timing of disease within studied periods

Label: 3, with a score of: 0.46819258470986
WordScorePoS
rural0JJ
average0NN
round0NN
height0NN
measure0NN
means0NNS
recall0NN
child0.10682408961305NN
mother0.162963395911232NN
growth0NN
rate0.0433561464459019NN
free0JJ
period0NN
compare0.0307735781890304VB
prevalence0.0407408489778079NN
attention0NN
disease0.215415047323213NN
study0NN

Label: 2, with a score of: 0.425196714182332
WordScorePoS
rural0.148975141598503JJ
average0NN
round0.11668334276823NN
height0NN
measure0.0504000902222448NN
means0NNS
recall0NN
child0.0546336178945768NN
mother0NN
growth0.0252000451111224NN
rate0.0155217067874935NN
free0JJ
period0.0440683498519077NN
compare0VB
prevalence0NN
attention0NN
disease0NN
study0NN

Label: 10, with a score of: 0.364906989954525
WordScorePoS
rural0.0330412182586772JJ
average0.146608885563018NN
round0NN
height0NN
measure0NN
means0NNS
recall0NN
child0.0242343960710022NN
mother0NN
growth0.11178243319132NN
rate0.0172128079963482NN
free0JJ
period0NN
compare0VB
prevalence0NN
attention0.0396106020715138NN
disease0NN
study0NN

Label: 8, with a score of: 0.361722425697641
WordScorePoS
rural0JJ
average0NN
round0NN
height0NN
measure0.0347609334428716NN
means0NNS
recall0NN
child0.0452169560888236NN
mother0NN
growth0.208565600657229NN
rate0NN
free0JJ
period0NN
compare0VB
prevalence0NN
attention0NN
disease0NN
study0NN

Label: 13, with a score of: 0.202356205704045
WordScorePoS
rural0JJ
average0.1656430212089NN
round0NN
height0NN
measure0.0710409787438328NN
means0NNS
recall0NN
child0NN
mother0NN
growth0NN
rate0NN
free0JJ
period0NN
compare0.0414107553022249VB
prevalence0NN
attention0NN
disease0NN
study0NN

Label: 1, with a score of: 0.452133004683177
WordScorePoS
rural0JJ
average0NN
round0NN
height0.120266261535276NN
measure0.103895385378356NN
means0.120266261535276NNS
recall0NN
child0.0450489732120807NN
mother0NN
growth0.0519476926891779NN
rate0.0639932865717261NN
free0JJ
period0NN
compare0VB
prevalence0NN
attention0NN
disease0NN
study0NN

Age season Notes ok if blank Effect of Disease on Malnutrition Weight gain deficits from day of diarrhea and cough or cold was and grams respectively External comparison revealed that almost all weight gain deficit was due to infections though internal comparison revealed little weight gain deficit attributable to infections regression techniques revealed dose response

Label: 3, with a score of: 0.632230068261084
WordScorePoS
age0.0893142758861673NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
gain0NN
day0.0175975629039954NN
external0JJ
due0JJ
infection0.122222546933424NN
response0NN

Label: 1, with a score of: 0.555863873090153
WordScorePoS
age0.112994637345193NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
gain0NN
day0.25973846344589NN
external0JJ
due0.0519476926891779JJ
infection0NN
response0NN

Study infants had ready access to pediatrician whenever they were ill

Label: 4, with a score of: 0.706996366128037
WordScorePoS
study0NN
infant0NN
ready0.0815069365350084JJ
access0.00697628678506322NN

Label: 2, with a score of: 0.526009009958157
WordScorePoS
study0NN
infant0.0583416713841148NN
ready0JJ
access0.00749031153171887NN

Combined effect of acute lower respiratory infection and diarrhea was grams but there was no effect on height acute lower respiratory infection impact varied by season effects were exclusively found among nonbreastfed babies regression techniques revealed doseresponse

Label: 0, with a score of: 1

Effective case management with oral rehydration therapy was organized within the study

Label: 16, with a score of: 0.67373969227324
WordScorePoS
effective0.0482582488828229JJ
management0NN
therapy0NN
organize0.107490825192354VB
study0NN

Label: 15, with a score of: 0.434051006884273
WordScorePoS
effective0JJ
management0.0486060126274891NN
therapy0NN
organize0VB
study0.0517339898971162NN

of periods excluded because of missing data Only transient changes in growth were observed and were caught up later though dysenteric patients were observed to experience stunting with month lag

Label: 8, with a score of: 0.621545838691306
WordScorePoS
period0NN
datum0NN
growth0.208565600657229NN
experience0NN
stunt0NN

Label: 2, with a score of: 0.554154320847134
WordScorePoS
period0.0440683498519077NN
datum0NN
growth0.0252000451111224NN
experience0NN
stunt0.11668334276823NN

continued TABLE A

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Setting Colombia Lutter Urban and others setting with at least half of siblings under who were less than weight for age

Label: 3, with a score of: 0.588282412451921
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
urban0JJ
age0.0893142758861673NN

Label: 11, with a score of: 0.510862472034977
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0273960270556257NN
develop0VB
country0NN
continue0.0537696560159885VB
set0NN
urban0.27622591898666JJ
age0NN

Brazil Schorling and others Number of Children control supplement Urban slum in northeastern Brazil where an exceptionally high rate of endemic diarrhea persists Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank months months Semimonthly visits Semimonthly to establish incidence and duration of diarrhea vomiting and respiratory and skin infections to establish period prevalence diarrhea prevalence

Label: 11, with a score of: 0.441479118682038
WordScorePoS
child0.0273960270556257NN
control0NN
urban0.27622591898666JJ
slum0.146277152173395NN
rate0NN
persist0VB
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
establish0VB
incidence0NN
infection0NN
prevalence0NN

Label: 3, with a score of: 0.530411924278804
WordScorePoS
child0.10682408961305NN
control0.020806307400253NN
urban0JJ
slum0NN
rate0.0433561464459019NN
persist0VB
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
establish0VB
incidence0.0407408489778079NN
infection0.122222546933424NN
prevalence0.0407408489778079NN

according to age Linear regression and way analysis of variance were used to model either increment of weight and height since birth or absolute height and weight until months

Label: 1, with a score of: 0.876461060603328
WordScorePoS
age0.112994637345193NN
height0.120266261535276NN
birth0NN

Label: 3, with a score of: 0.406943128817546
WordScorePoS
age0.0893142758861673NN
height0NN
birth0.0748292956291867NN

Age treatment group size at birth years months Three times week Monthly during third year extensive stool specimens collected from acute persistent and control children specimens subject to intensive microbiological testing Descriptive time series analysis was made

Label: 3, with a score of: 0.644645044432178
WordScorePoS
age0.0893142758861673NN
treatment0.0624189222007589NN
size0NN
birth0.0748292956291867NN
time0.0127591822694525NN
persistent0.0307735781890304JJ
control0.020806307400253NN
child0.10682408961305NN
intensive0JJ

Age Notes ok if blank Effect of Disease on Malnutrition Throughout the study families received free obstetric and pediatric care including medicine the supplement group received kilocalories and grams of protein

Label: 3, with a score of: 0.881734061631095
WordScorePoS
age0.0893142758861673NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
study0NN
family0.0624189222007589NN
receive0.0814816979556159VB
free0JJ
care0.104031537001265NN
include0VB
medicine0.123094312756122NN
protein0NN

Each day ill with diarrhea is associated with reduction

Label: 1, with a score of: 0.929243287279102
WordScorePoS
day0.25973846344589NN
reduction0NN

cm <

Label: 0, with a score of: 1

in attained length at age mo food supplements effectively mitigated growth faltering

Label: 2, with a score of: 0.672973426831954
WordScorePoS
attain0VB
age0.0365427838531249NN
food0.292342270824999NN
effectively0RB
growth0.0252000451111224NN

Label: 8, with a score of: 0.444301179611444
WordScorePoS
attain0VB
age0.0252035516550537NN
food0NN
effectively0RB
growth0.208565600657229NN

Label: 12, with a score of: 0.355214926866499
WordScorePoS
attain0VB
age0NN
food0.186896403054502NN
effectively0RB
growth0NN

Label: 1, with a score of: 0.313489059943348
WordScorePoS
attain0VB
age0.112994637345193NN
food0NN
effectively0RB
growth0.0519476926891779NN

centimeters by age months especially among children who experienced greater than diarrhea period prevalence the difference between this group and the WHO World Health Organization standard was centimeters at months that is the treatment group experienced growth faltering of about centimeters regression techniques revealed dose response

Label: 3, with a score of: 0.660571187436655
WordScorePoS
age0.0893142758861673NN
child0.10682408961305NN
experienced0JJ
period0NN
prevalence0.0407408489778079NN
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
standard0NN
treatment0.0624189222007589NN
growth0NN
response0NN

Label: 8, with a score of: 0.409285370064888
WordScorePoS
age0.0252035516550537NN
child0.0452169560888236NN
experienced0JJ
period0NN
prevalence0NN
world0.00172202218602071NN
health0NN
organization0.0347609334428716NN
standard0NN
treatment0NN
growth0.208565600657229NN
response0NN

Label: 10, with a score of: 0.338045356424983
WordScorePoS
age0.0202620733250388NN
child0.0242343960710022NN
experienced0JJ
period0NN
prevalence0NN
world0.00276879546803864NN
health0.0405241466500776NN
organization0.02794560829783NN
standard0NN
treatment0.0330412182586772NN
growth0.11178243319132NN
response0NN

Authors noted that the greatest contribution to the declines came from increase in the prevalence of persistent diarrhea and that this decline closely followed decrease in the prevalence of severe malnutrition weight for age

Label: 3, with a score of: 0.680933752715443
WordScorePoS
contribution0NN
decline0.0351951258079907NN
increase0.0143984997539974NN
prevalence0.0407408489778079NN
persistent0.0307735781890304JJ
decrease0NN
malnutrition0NN
age0.0893142758861673NN

Label: 1, with a score of: 0.443780016960159
WordScorePoS
contribution0NN
decline0NN
increase0NN
prevalence0NN
persistent0JJ
decrease0NN
malnutrition0.0736315832425121NN
age0.112994637345193NN

control children also had high rates of diarrheagenic agents

Label: 3, with a score of: 0.544690938772114
WordScorePoS
control0.020806307400253NN
child0.10682408961305NN
rate0.0433561464459019NN

Label: 1, with a score of: 0.543020312482483
WordScorePoS
control0.0614198493690006NN
child0.0450489732120807NN
rate0.0639932865717261NN

Label: 16, with a score of: 0.374594967177219
WordScorePoS
control0NN
child0.0603953832457135NN
rate0.0571955184484387NN

Label: 4, with a score of: 0.312222761163178
WordScorePoS
control0NN
child0.076326555629389NN
rate0.0216847879059514NN

Country study Number of Setting Children Bangladesh Becker Black and Brown Rural villages in Matlab area Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy months Up to months Home visits every second day by health worker who recorded diarrhea vomiting nasal discharge cough anorexia and fever Brazil Victora Relatively wealthy and others urban setting months Every second During two surveys year every second year mothers probed about hospitalizations caused by for example pneumonia and diarrhea validation done by reviewing records of hospitalizations Comparisons were made of mean standard scores among hospitalized and nonhospitalized children

Label: 3, with a score of: 0.501675836444702
WordScorePoS
country0NN
study0NN
set0NN
child0.10682408961305NN
rural0JJ
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
day0.0175975629039954NN
health0.191387734041787NN
worker0NN
record0NN
discharge0NN
urban0JJ
survey0NN
mother0.162963395911232NN
cause0NN
review0NN
standard0NN

Label: 1, with a score of: 0.456167627103405
WordScorePoS
country0NN
study0NN
set0NN
child0.0450489732120807NN
rural0JJ
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
day0.25973846344589NN
health0NN
worker0NN
record0NN
discharge0NN
urban0JJ
survey0NN
mother0NN
cause0NN
review0NN
standard0NN

Label: 11, with a score of: 0.317091771568061
WordScorePoS
country0NN
study0NN
set0NN
child0.0273960270556257NN
rural0.0373517915079663JJ
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
day0NN
health0.0229054731708393NN
worker0NN
record0NN
discharge0NN
urban0.27622591898666JJ
survey0NN
mother0NN
cause0.04477822029736NN
review0NN
standard0NN

Label: 2, with a score of: 0.24640937514635
WordScorePoS
country0NN
study0NN
set0NN
child0.0546336178945768NN
rural0.148975141598503JJ
age0.0365427838531249NN
period0.0440683498519077NN
exposure0NN
datum0NN
collection0NN
strategy0NN
day0NN
health0NN
worker0NN
record0NN
discharge0NN
urban0JJ
survey0NN
mother0NN
cause0NN
review0NN
standard0NN

Zimbabwe Moy and others months months Weekly maternal recall to establish period prevalence Comparisons of growth rates between diarrhea free periods and periods with varying period prevalence of diarrhea with attention paid to timing of disease within studied Rural impoverished setting where caloric intake was of recommended months Monthly Monthly Control Variables ok if blank Energy Three different intake age random effects models were used with morbidity period prevalence fitted as independent variables

Label: 3, with a score of: 0.549682721296453
WordScorePoS
maternal0.184641469134183JJ
recall0NN
establish0VB
period0NN
prevalence0.0407408489778079NN
growth0NN
rate0.0433561464459019NN
free0JJ
attention0NN
pay0NN
disease0.215415047323213NN
study0NN
rural0JJ
set0NN
intake0NN
recommend0.0407408489778079VB
control0.020806307400253NN
energy0NN
age0.0893142758861673NN
effect0NN

Label: 7, with a score of: 0.404446294369475
WordScorePoS
maternal0JJ
recall0NN
establish0VB
period0NN
prevalence0NN
growth0NN
rate0.0325677023224526NN
free0JJ
attention0NN
pay0NN
disease0NN
study0NN
rural0JJ
set0NN
intake0NN
recommend0VB
control0NN
energy0.494617163780726NN
age0NN
effect0NN

Label: 2, with a score of: 0.386464506335971
WordScorePoS
maternal0JJ
recall0NN
establish0VB
period0.0440683498519077NN
prevalence0NN
growth0.0252000451111224NN
rate0.0155217067874935NN
free0JJ
attention0NN
pay0NN
disease0NN
study0NN
rural0.148975141598503JJ
set0NN
intake0NN
recommend0VB
control0NN
energy0.0130963126055467NN
age0.0365427838531249NN
effect0.0440683498519077NN

Label: 12, with a score of: 0.2854466865942
WordScorePoS
maternal0JJ
recall0NN
establish0VB
period0.0409791940864438NN
prevalence0NN
growth0NN
rate0NN
free0.0332151194779746JJ
attention0NN
pay0NN
disease0NN
study0NN
rural0JJ
set0NN
intake0NN
recommend0VB
control0NN
energy0.133960988253756NN
age0NN
effect0NN

Label: 8, with a score of: 0.23267915434844
WordScorePoS
maternal0JJ
recall0NN
establish0VB
period0NN
prevalence0NN
growth0.208565600657229NN
rate0NN
free0JJ
attention0NN
pay0.0695218668857431NN
disease0NN
study0NN
rural0JJ
set0NN
intake0NN
recommend0VB
control0NN
energy0NN
age0.0252035516550537NN
effect0NN

Notes ok if blank Effect of Disease on Malnutrition Matlab is special observation region where many observational epidemiological studies are carried out by the International Centre for Diarrhoeal Disease Research

Label: 3, with a score of: 0.738242831194349
WordScorePoS
effect0NN
disease0.215415047323213NN
malnutrition0NN
special0JJ
region0.124837844401518NN
study0NN
international0JJ
centre0NN
diarrhoeal0NN
research0.0175975629039954NN

Label: 1, with a score of: 0.338950404439049
WordScorePoS
effect0NN
disease0NN
malnutrition0.0736315832425121NN
special0JJ
region0.184259548107002NN
study0NN
international0.00531301439641424JJ
centre0NN
diarrhoeal0NN
research0NN

Label: 6, with a score of: 0.456577658589078
WordScorePoS
effect0NN
disease0.103230094596636NN
malnutrition0.041835863322702NN
special0.0348974218717993JJ
region0NN
study0NN
international0.00301873916506525JJ
centre0NN
diarrhoeal0.0683326727248364NN
research0NN

If diarrhea and fever were reduced to the level of U

Label: 16, with a score of: 0.688076002231361
WordScorePoS
reduce0.0220985725470694VB
level0.0610668815653026NN

Label: 13, with a score of: 0.374666597651223
WordScorePoS
reduce0.00375696197697663VB
level0.0415277415054218NN

study children would gain grams per month more regression techniques revealed dose response

Label: 3, with a score of: 0.484197639777179
WordScorePoS
study0NN
child0.10682408961305NN
gain0NN
response0NN

Age sex income level birthweight Effect of early infancy hospitalizations strongly predicted growth faltering at months though pneumonia unlike diarrhea was statistically significantly linked with stunting for example early infanthood diarrhea and pneumonia hospitalizations decreased mean height for age score by about and respectively

Label: 10, with a score of: 0.483649501298878
WordScorePoS
age0.0202620733250388NN
sex0.064698038783335NN
income0.166475342664294NN
level0NN
effect0NN
predict0VB
growth0.11178243319132NN
significantly0RB
stunt0NN
decrease0NN
height0NN

Label: 8, with a score of: 0.336229834033276
WordScorePoS
age0.0252035516550537NN
sex0NN
income0NN
level0.00761994916892276NN
effect0NN
predict0VB
growth0.208565600657229NN
significantly0RB
stunt0NN
decrease0NN
height0NN

Label: 1, with a score of: 0.572336796415312
WordScorePoS
age0.112994637345193NN
sex0NN
income0.0442083771593746NN
level0.0113874611101829NN
effect0NN
predict0VB
growth0.0519476926891779NN
significantly0RB
stunt0NN
decrease0NN
height0.120266261535276NN

Label: 2, with a score of: 0.414810613283698
WordScorePoS
age0.0365427838531249NN
sex0NN
income0.0643370113878709NN
level0.00552410547653725NN
effect0.0440683498519077NN
predict0VB
growth0.0252000451111224NN
significantly0RB
stunt0.11668334276823NN
decrease0NN
height0NN

Children were exclusively breastfed until months all children were fully immunized and were mothers trained to treat children with oral rehydration Authors found very little difference in growth rates with the most diarrhea and with least study showed that diarrheal episode led to grams and

Label: 3, with a score of: 0.629924164724698
WordScorePoS
child0.10682408961305NN
fully0RB
mother0.162963395911232NN
growth0NN
rate0.0433561464459019NN
study0NN
lead0.025518364538905NN

Label: 8, with a score of: 0.450078479523149
WordScorePoS
child0.0452169560888236NN
fully0RB
mother0NN
growth0.208565600657229NN
rate0NN
study0NN
lead0.0504071033101074NN

centimeters of growth loss which could not explain the significant growth faltering in the in the cohort continued TABLE A

Label: 8, with a score of: 0.762745253648097
WordScorePoS
growth0.208565600657229NN
loss0NN
significant0JJ
continue0.0295821503613099VB

Label: 10, with a score of: 0.491528615232637
WordScorePoS
growth0.11178243319132NN
loss0NN
significant0.0405241466500776JJ
continue0.0237821918091848VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Number of Setting Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank periods in addition growth rates were compared between Philippines Adair and others Urban and infants rural areas around and within Cebu months months Bimonthly Bimonthly maternal recall prior week of acute respiratory infection and diarrhea episodes Lagged weight gain was regressed against morbidity an instrumental variables technique was used as explanatory variables were correlated

Label: 3, with a score of: 0.598835301142009
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
addition0NN
growth0NN
rate0.0433561464459019NN
compare0.0307735781890304VB
urban0JJ
infant0NN
rural0JJ
maternal0.184641469134183JJ
recall0NN
infection0.122222546933424NN
gain0NN

Label: 2, with a score of: 0.368877081036987
WordScorePoS
study0NN
disease0NN
nutritional0.0583416713841148JJ
status0NN
child0.0546336178945768NN
develop0VB
country0NN
continue0VB
set0NN
age0.0365427838531249NN
period0.0440683498519077NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
addition0.0357189919948307NN
growth0.0252000451111224NN
rate0.0155217067874935NN
compare0VB
urban0JJ
infant0.0583416713841148NN
rural0.148975141598503JJ
maternal0JJ
recall0NN
infection0NN
gain0NN

Label: 11, with a score of: 0.298995622107358
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0273960270556257NN
develop0VB
country0NN
continue0.0537696560159885VB
set0NN
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
addition0NN
growth0NN
rate0NN
compare0VB
urban0.27622591898666JJ
infant0NN
rural0.0373517915079663JJ
maternal0JJ
recall0NN
infection0NN
gain0.04477822029736NN

Label: 8, with a score of: 0.245493324329578
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0452169560888236NN
develop0VB
country0NN
continue0.0295821503613099VB
set0NN
age0.0252035516550537NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0295821503613099NN
control0NN
addition0NN
growth0.208565600657229NN
rate0NN
compare0VB
urban0JJ
infant0NN
rural0JJ
maternal0JJ
recall0NN
infection0NN
gain0NN

Sudan Harrison Brush and Zumrawi Poor months perimother infant urban pairs Khartoum months Biweekly recall Comparison was made of mean duration of illness and growth of children born to housewives and nonhousewives Monthly Notes ok if blank supplements

Label: 11, with a score of: 0.530230438033364
WordScorePoS
poor0.0229054731708393JJ
infant0NN
urban0.27622591898666JJ
recall0NN
illness0NN
growth0NN
child0.0273960270556257NN
bear0NN

Label: 8, with a score of: 0.412103940774594
WordScorePoS
poor0JJ
infant0NN
urban0JJ
recall0NN
illness0NN
growth0.208565600657229NN
child0.0452169560888236NN
bear0NN

Label: 1, with a score of: 0.402155648587379
WordScorePoS
poor0.150659516460257JJ
infant0NN
urban0JJ
recall0NN
illness0NN
growth0.0519476926891779NN
child0.0450489732120807NN
bear0NN

high more than and low fewer than occurrence of diarrhea in months

Label: 0, with a score of: 1

Breast feeding and energy intake from other sources preventive health care maternal weight season of measurement Effect of Disease on Malnutrition timing of diarrhea within the month periods suggested that growth faltering was transient though with respect to linear growth it was not clear cut

Label: 3, with a score of: 0.600246240477377
WordScorePoS
energy0NN
intake0NN
source0NN
health0.191387734041787NN
care0.104031537001265NN
maternal0.184641469134183JJ
measurement0NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
period0NN
suggest0VB
growth0NN
respect0.0249430985430622NN
cut0NN

Label: 7, with a score of: 0.435005389606965
WordScorePoS
energy0.494617163780726NN
intake0NN
source0.0274787313211514NN
health0NN
care0NN
maternal0JJ
measurement0NN
effect0NN
disease0NN
malnutrition0NN
period0NN
suggest0VB
growth0NN
respect0NN
cut0NN

Label: 8, with a score of: 0.347549793912113
WordScorePoS
energy0NN
intake0NN
source0NN
health0NN
care0NN
maternal0JJ
measurement0NN
effect0NN
disease0NN
malnutrition0NN
period0NN
suggest0VB
growth0.208565600657229NN
respect0NN
cut0NN

Label: 12, with a score of: 0.174071301073147
WordScorePoS
energy0.133960988253756NN
intake0NN
source0NN
health0.0339811641917276NN
care0NN
maternal0JJ
measurement0NN
effect0NN
disease0NN
malnutrition0NN
period0.0409791940864438NN
suggest0VB
growth0NN
respect0NN
cut0NN

Recent diarrhea had substantial significant negative effect on weight of children after months of life whereas acute respiratory infections significantly negatively affected growth up to months of life

Label: 8, with a score of: 0.459104595641901
WordScorePoS
substantial0JJ
significant0JJ
effect0NN
child0.0452169560888236NN
life0.0123650647908625NN
infection0NN
significantly0RB
negatively0RB
affect0VB
growth0.208565600657229NN

Label: 3, with a score of: 0.491464551957907
WordScorePoS
substantial0JJ
significant0.0127591822694525JJ
effect0NN
child0.10682408961305NN
life0.0250390290383647NN
infection0.122222546933424NN
significantly0RB
negatively0RB
affect0.00625975725959118VB
growth0NN

Label: 1, with a score of: 0.434735276873914
WordScorePoS
substantial0.0736315832425121JJ
significant0.0376648791150643JJ
effect0NN
child0.0450489732120807NN
life0.0184786920895884NN
infection0NN
significantly0RB
negatively0RB
affect0.0184786920895884VB
growth0.0519476926891779NN

Regression coefficients approximately grams lagged or immediate effects of diarrhea or acute respiratory infections in either month or month period results are suggestive of lasting irreversible effects breastfeeding was strongly protective

Label: 0, with a score of: 1

Housewives children were on average

Label: 10, with a score of: 0.58167242354743
WordScorePoS
child0.0242343960710022NN
average0.146608885563018NN

Label: 13, with a score of: 0.563967026790667
WordScorePoS
child0NN
average0.1656430212089NN

Label: 3, with a score of: 0.363705417644573
WordScorePoS
child0.10682408961305NN
average0NN

centimeters longer at months although they were shorter at birth on average illness duration at months was up to times onger among children born to working mothers despite the fact that such children tended to have Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition less access to water supply sewage systems and general conditions of hygiene

Label: 3, with a score of: 0.575554802264517
WordScorePoS
birth0.0748292956291867NN
average0NN
illness0.0407408489778079NN
time0.0127591822694525NN
child0.10682408961305NN
bear0.0814816979556159NN
mother0.162963395911232NN
country0NN
study0NN
set0NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
access0.00610236075888593NN
water0.0382775468083574NN
supply0NN
sewage0NN
system0NN
condition0NN
hygiene0NN

Label: 6, with a score of: 0.523842764969556
WordScorePoS
birth0NN
average0NN
illness0NN
time0NN
child0.0255958462813622NN
bear0NN
mother0NN
country0NN
study0NN
set0NN
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
effect0NN
disease0.103230094596636NN
malnutrition0.041835863322702NN
access0.00731085509381114NN
water0.556409482163189NN
supply0.0590310971343993NN
sewage0NN
system0NN
condition0NN
hygiene0.136665345449673NN

Label: 12, with a score of: 0.191364949402821
WordScorePoS
birth0NN
average0NN
illness0NN
time0.0169905820958638NN
child0NN
bear0NN
mother0NN
country0NN
study0NN
set0NN
age0NN
period0.0409791940864438NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
effect0NN
disease0NN
malnutrition0NN
access0.00232174891244877NN
water0.186896403054502NN
supply0.0703006268489394NN
sewage0NN
system0NN
condition0.0409791940864438NN
hygiene0NN

Label: 10, with a score of: 0.182229650166594
WordScorePoS
birth0.0396106020715138NN
average0.146608885563018NN
illness0NN
time0.0607862199751165NN
child0.0242343960710022NN
bear0NN
mother0NN
country0NN
study0NN
set0NN
age0.0202620733250388NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
effect0NN
disease0NN
malnutrition0NN
access0.00138439773401932NN
water0NN
supply0NN
sewage0NN
system0NN
condition0NN
hygiene0NN

Label: 13, with a score of: 0.0991852810029277
WordScorePoS
birth0NN
average0.1656430212089NN
illness0NN
time0NN
child0NN
bear0NN
mother0NN
country0NN
study0NN
set0NN
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0201523636533764NN
control0NN
effect0NN
disease0NN
malnutrition0NN
access0NN
water0NN
supply0NN
sewage0NN
system0NN
condition0NN
hygiene0NN

Label: 1, with a score of: 0.322847138175135
WordScorePoS
birth0NN
average0NN
illness0NN
time0NN
child0.0450489732120807NN
bear0NN
mother0NN
country0NN
study0NN
set0NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
access0.00514687440545096NN
water0NN
supply0NN
sewage0NN
system0.0519476926891779NN
condition0NN
hygiene0NN

Honduras Cohen and others Lowincome communities in San Pedro Sula where environmental sanitation was poor months motherchild pairs participating in randomized trial of treatment groups Sudan Peri urban Brush Khar toum Harrison and Waterlow months months Morbidity data upper respiratory infection fever diarrhea collected at less than months during weekly visits day recall mothers kept stool frequency and consistency records to establish period prevalence about

Label: 6, with a score of: 0.500716760378301
WordScorePoS
community0.0214003646985842NN
environmental0JJ
sanitation0.334686906581616NN
poor0.0642010940957526JJ
treatment0.0348974218717993NN
perus0NN
urban0JJ
datum0NN
infection0NN
day0.0295155485671997NN
recall0NN
mother0NN
record0NN
establish0VB
period0NN
prevalence0NN

Label: 1, with a score of: 0.469627388120368
WordScorePoS
community0NN
environmental0.0442083771593746JJ
sanitation0NN
poor0.150659516460257JJ
treatment0NN
perus0NN
urban0JJ
datum0NN
infection0NN
day0.25973846344589NN
recall0NN
mother0NN
record0NN
establish0VB
period0NN
prevalence0NN

Label: 3, with a score of: 0.445123654660189
WordScorePoS
community0NN
environmental0JJ
sanitation0.0249430985430622NN
poor0JJ
treatment0.0624189222007589NN
perus0NN
urban0JJ
datum0NN
infection0.122222546933424NN
day0.0175975629039954NN
recall0NN
mother0.162963395911232NN
record0NN
establish0VB
period0NN
prevalence0.0407408489778079NN

Label: 11, with a score of: 0.440116757866316
WordScorePoS
community0NN
environmental0.0537696560159885JJ
sanitation0NN
poor0.0229054731708393JJ
treatment0NN
perus0.0731385760866977NN
urban0.27622591898666JJ
datum0NN
infection0NN
day0NN
recall0NN
mother0NN
record0NN
establish0VB
period0NN
prevalence0NN

for diarrhea at greater than months monthly visits probed day recall

Label: 1, with a score of: 0.94945045109491
WordScorePoS
day0.25973846344589NN
recall0NN

Monthly between and months before that either weekly or more irregularly at less than weeks Comparison was made of growth velocities between treatment groups and U

Label: 8, with a score of: 0.764970851347063
WordScorePoS
growth0.208565600657229NN
treatment0NN

Label: 10, with a score of: 0.531179981721759
WordScorePoS
growth0.11178243319132NN
treatment0.0330412182586772NN

standards at months months months

Label: 9, with a score of: 0.742868974909555
WordScorePoS
standard0.0454743001434393NN

Label: 12, with a score of: 0.66943684251528
WordScorePoS
standard0.0409791940864438NN

Sex birthweight maternal height age and education group income potable water intervention group breast milk energy at months income maternal BMI at months months Biweekly mother recall of the duration of illness Monthly Infancy was divided into periods of greater than months and less than months and biweekly period prevalence was regressed with growth parameters

Label: 3, with a score of: 0.512947009868037
WordScorePoS
sex0NN
maternal0.184641469134183JJ
height0NN
age0.0893142758861673NN
education0.0152605842304358NN
income0NN
water0.0382775468083574NN
intervention0.0407408489778079NN
energy0NN
mother0.162963395911232NN
recall0NN
illness0.0407408489778079NN
period0NN
prevalence0.0407408489778079NN
growth0NN

Label: 10, with a score of: 0.411446557199164
WordScorePoS
sex0.064698038783335NN
maternal0.0488696285210061JJ
height0NN
age0.0202620733250388NN
education0.0121171980355011NN
income0.166475342664294NN
water0NN
intervention0NN
energy0NN
mother0NN
recall0NN
illness0NN
period0NN
prevalence0NN
growth0.11178243319132NN

Label: 7, with a score of: 0.376103018408472
WordScorePoS
sex0NN
maternal0JJ
height0NN
age0NN
education0NN
income0.0449973847138318NN
water0NN
intervention0NN
energy0.494617163780726NN
mother0NN
recall0NN
illness0NN
period0NN
prevalence0NN
growth0NN

Label: 6, with a score of: 0.367827507405797
WordScorePoS
sex0NN
maternal0JJ
height0NN
age0NN
education0NN
income0NN
water0.556409482163189NN
intervention0NN
energy0.0153390539205676NN
mother0NN
recall0NN
illness0NN
period0NN
prevalence0NN
growth0NN

Label: 12, with a score of: 0.265683469016234
WordScorePoS
sex0NN
maternal0JJ
height0NN
age0NN
education0.0101607690729067NN
income0NN
water0.186896403054502NN
intervention0NN
energy0.133960988253756NN
mother0NN
recall0NN
illness0NN
period0.0409791940864438NN
prevalence0NN
growth0NN

Label: 4, with a score of: 0.173554069663059
WordScorePoS
sex0NN
maternal0JJ
height0NN
age0.0255262687343935NN
education0.244244978014045NN
income0NN
water0NN
intervention0NN
energy0NN
mother0NN
recall0NN
illness0NN
period0NN
prevalence0NN
growth0NN

Label: 8, with a score of: 0.160089151512687
WordScorePoS
sex0NN
maternal0JJ
height0NN
age0.0252035516550537NN
education0.0150723186962745NN
income0NN
water0NN
intervention0NN
energy0NN
mother0NN
recall0NN
illness0NN
period0NN
prevalence0NN
growth0.208565600657229NN

Mother socioeconomic status and income age of weaning and disease duration at under months Willingness to breastfeed for weeks was an inclusion criterion and during weekly visits this habit was encouraged hygienic food was provided during postweaning period for those arms who discontinued exclusive breastfeeding according to the intervention protocol

Label: 3, with a score of: 0.603630067806949
WordScorePoS
mother0.162963395911232NN
status0NN
income0NN
age0.0893142758861673NN
disease0.215415047323213NN
inclusion0NN
criterion0NN
habit0NN
encouraged0JJ
food0NN
period0NN
arm0NN
intervention0.0407408489778079NN

Label: 2, with a score of: 0.519166435841538
WordScorePoS
mother0NN
status0NN
income0.0643370113878709NN
age0.0365427838531249NN
disease0NN
inclusion0NN
criterion0NN
habit0NN
encouraged0JJ
food0.292342270824999NN
period0.0440683498519077NN
arm0NN
intervention0NN

Label: 10, with a score of: 0.337740629663078
WordScorePoS
mother0NN
status0.0488696285210061NN
income0.166475342664294NN
age0.0202620733250388NN
disease0NN
inclusion0.0488696285210061NN
criterion0NN
habit0NN
encouraged0JJ
food0NN
period0NN
arm0NN
intervention0NN

Label: 12, with a score of: 0.334951685996132
WordScorePoS
mother0NN
status0NN
income0NN
age0NN
disease0NN
inclusion0NN
criterion0NN
habit0.0542519672965169NN
encouraged0JJ
food0.186896403054502NN
period0.0409791940864438NN
arm0NN
intervention0NN

There was an initial rapid catchup compared with the U

Label: 3, with a score of: 0.597432098380373
WordScorePoS
rapid0.020806307400253JJ
compare0.0307735781890304VB

Label: 13, with a score of: 0.479646555107222
WordScorePoS
rapid0JJ
compare0.0414107553022249VB

data at less than months after months and especially at greater than months rapid growthfaltering intrauterine growth restriction was strong predictor of stunting fever but not diarrhea predicted growth faltering between and months the low morbidity rates and lack of association of diarrhea with growth may be attributable to the study emphasis on breastfeeding

Label: 8, with a score of: 0.709903250287913
WordScorePoS
datum0NN
rapid0JJ
growth0.208565600657229NN
restriction0NN
strong0JJ
stunt0NN
predict0VB
rate0NN
lack0.0252035516550537NN
study0NN

Duration of illness in the first months was strongly inversely related to length and weight growth at months

Label: 8, with a score of: 0.806255890914592
WordScorePoS
illness0NN
related0.0123650647908625JJ
growth0.208565600657229NN

Label: 10, with a score of: 0.407934521350744
WordScorePoS
illness0NN
related0JJ
growth0.11178243319132NN

continued TABLE A

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Number of Setting Children followed for child years GuineaBissau Molbak and others Periurban district of Bandim II Indonesia Kolsteren Kusin and Kardjati Rural Indonesia where childhood infections are relatively rare Peru Checkley and others Periurban shantytown Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Approximately Biweekly visits by months field workers stool specimens collected the same day if child was sick Growth faltering was studied in different age groups less than year years with three different lag periods and common estimate

Label: 3, with a score of: 0.567121330086554
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
rural0JJ
childhood0NN
infection0.122222546933424NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
approximately0RB
field0NN
worker0NN
day0.0175975629039954NN
growth0NN
common0.0615471563780609JJ
estimate0.059903311017139NN

Label: 1, with a score of: 0.478570484974564
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0450489732120807NN
develop0VB
country0NN
continue0VB
set0NN
rural0JJ
childhood0NN
infection0NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN
approximately0RB
field0NN
worker0NN
day0.25973846344589NN
growth0.0519476926891779NN
common0JJ
estimate0NN

Label: 2, with a score of: 0.340059652797129
WordScorePoS
study0NN
disease0NN
nutritional0.0583416713841148JJ
status0NN
child0.0546336178945768NN
develop0VB
country0NN
continue0VB
set0NN
rural0.148975141598503JJ
childhood0NN
infection0NN
age0.0365427838531249NN
period0.0440683498519077NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
approximately0RB
field0.0583416713841148NN
worker0NN
day0NN
growth0.0252000451111224NN
common0JJ
estimate0NN

Label: 8, with a score of: 0.33231453539446
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0452169560888236NN
develop0VB
country0NN
continue0.0295821503613099VB
set0NN
rural0JJ
childhood0NN
infection0NN
age0.0252035516550537NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0295821503613099NN
control0NN
approximately0RB
field0NN
worker0.121575732851624NN
day0.0347609334428716NN
growth0.208565600657229NN
common0JJ
estimate0NN

Preinfection weight sex age season and age at infection months months Weekly visits by Monthly health worker ill children revisited after days to establish period prevalence of acute respiratory infection diarrhea and fever Period prevalence of acute respiratory infections and diarrhea was associated with growth velocity in week periods

Label: 3, with a score of: 0.726644042197809
WordScorePoS
sex0NN
age0.0893142758861673NN
infection0.122222546933424NN
health0.191387734041787NN
worker0NN
child0.10682408961305NN
day0.0175975629039954NN
establish0VB
period0NN
prevalence0.0407408489778079NN
growth0NN

Label: 1, with a score of: 0.449224413197798
WordScorePoS
sex0NN
age0.112994637345193NN
infection0NN
health0NN
worker0NN
child0.0450489732120807NN
day0.25973846344589NN
establish0VB
period0NN
prevalence0NN
growth0.0519476926891779NN

Label: 8, with a score of: 0.355021460030848
WordScorePoS
sex0NN
age0.0252035516550537NN
infection0NN
health0NN
worker0.121575732851624NN
child0.0452169560888236NN
day0.0347609334428716NN
establish0VB
period0NN
prevalence0NN
growth0.208565600657229NN

Duration of specific disease episode sex age months Stool specimens collected weekly irrespective of symptoms diarrhea symptoms probed biweekly by health worker Comparison was made of growth velocity in month growth periods among those infected by Cryptosporidium first time infected Sex weight and stunting indicator at the start of period interaction of C

Label: 3, with a score of: 0.560259540684561
WordScorePoS
specific0JJ
disease0.215415047323213NN
sex0NN
age0.0893142758861673NN
irrespective0RB
health0.191387734041787NN
worker0NN
growth0NN
period0NN
infected0.0407408489778079JJ
time0.0127591822694525NN
stunt0NN

Label: 8, with a score of: 0.535160467434343
WordScorePoS
specific0JJ
disease0NN
sex0NN
age0.0252035516550537NN
irrespective0RB
health0NN
worker0.121575732851624NN
growth0.208565600657229NN
period0NN
infected0JJ
time0NN
stunt0NN

parvum and diarrhea presence of G

Label: 0, with a score of: 1

lamblia seasonality

Label: 0, with a score of: 1

months recruited at birth months months Monthly Notes ok if blank Effect of Disease on Malnutrition Long lasting growth faltering effect was observed in both weight and height velocities effects being most pronounced at under year

Label: 3, with a score of: 0.527673192037189
WordScorePoS
birth0.0748292956291867NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
last0JJ
growth0NN
height0NN

Label: 8, with a score of: 0.379178712420255
WordScorePoS
birth0NN
effect0NN
disease0NN
malnutrition0NN
last0JJ
growth0.208565600657229NN
height0NN

Label: 1, with a score of: 0.446954790517889
WordScorePoS
birth0NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
last0JJ
growth0.0519476926891779NN
height0.120266261535276NN

At less than year cryptosporidiosis lowered weight by and grams among boys and girls respectively respective results for height were

Label: 5, with a score of: 0.84528030652808
WordScorePoS
boy0.206598579091335NN
girl0.393804437159645NN
respective0JJ
result0NN
height0NN

Label: 4, with a score of: 0.458288815393684
WordScorePoS
boy0.184698660975968NN
girl0.140824109342254NN
respective0JJ
result0NN
height0NN

millimeters

Label: 0, with a score of: 1

Sick children were referred to the project clinic virtually all were breastfed until months

Label: 3, with a score of: 0.536407889524258
WordScorePoS
child0.10682408961305NN
project0NN

Weight indexes were significantly affected especially by acute respiratory infections after months of age but no effect on linear growth was observed duration of diarrhea acute respiratory infections and fever did not contribute to length velocity but weight velocity was adversely affected by acute respiratory infection duration

Label: 8, with a score of: 0.370570251960474
WordScorePoS
significantly0RB
affect0VB
infection0NN
age0.0252035516550537NN
effect0NN
growth0.208565600657229NN
contribute0VB

On average symptomatic and asymptomatic children gained and grams less after the first Cryptosporidium infection because asymptomatic infections are twice as common they might have bigger public health effect through malnutrition

Label: 3, with a score of: 0.791808870315049
WordScorePoS
average0NN
child0.10682408961305NN
gain0NN
infection0.122222546933424NN
common0.0615471563780609JJ
public0.021678073222951NN
health0.191387734041787NN
effect0NN
malnutrition0NN

Label: 10, with a score of: 0.289178816647227
WordScorePoS
average0.146608885563018NN
child0.0242343960710022NN
gain0NN
infection0NN
common0JJ
public0.0172128079963482NN
health0.0405241466500776NN
effect0NN
malnutrition0NN

Label: 13, with a score of: 0.209556406269052
WordScorePoS
average0.1656430212089NN
child0NN
gain0NN
infection0NN
common0JJ
public0NN
health0NN
effect0NN
malnutrition0NN

Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition included and first month after infection covered and those not infected

Label: 3, with a score of: 0.653962474147449
WordScorePoS
country0NN
study0NN
set0NN
child0.10682408961305NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
include0VB
infection0.122222546933424NN
cover0NN
infected0.0407408489778079JJ

Label: 1, with a score of: 0.490306274069335
WordScorePoS
country0NN
study0NN
set0NN
child0.0450489732120807NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
include0VB
infection0NN
cover0NN
infected0JJ

Brazil Steiner Shantyand others town in northeastern Brazil Peru Checkley and others Periurban Lima months months years months Stool samples collected periodically from healthy children and during each episode of diarrhea Weekly collection of stool specimens to diagnose C

Label: 0, with a score of: 1

parvum and biweekly diagnosis of diarrhea to establish period prevalence Quarterly Monthly measurements by health workers Growth of E

Label: 8, with a score of: 0.666541635261194
WordScorePoS
diagnosis0NN
establish0VB
period0NN
prevalence0NN
measurement0NN
health0NN
worker0.121575732851624NN
growth0.208565600657229NN

Label: 3, with a score of: 0.550912045708645
WordScorePoS
diagnosis0.0407408489778079NN
establish0VB
period0NN
prevalence0.0407408489778079NN
measurement0NN
health0.191387734041787NN
worker0NN
growth0NN

Label: 10, with a score of: 0.307500656490208
WordScorePoS
diagnosis0NN
establish0VB
period0NN
prevalence0NN
measurement0NN
health0.0405241466500776NN
worker0NN
growth0.11178243319132NN

coli Presence of Cohort was well EAggEC positive pathogens described

Label: 0, with a score of: 1

children with other than coli persistent and EAggEC acute diarrhea and children without diarrhea were compared with growth of children who were not carrying enteric pathogens

Label: 8, with a score of: 0.500139365402701
WordScorePoS
child0.0452169560888236NN
persistent0JJ
compare0VB
growth0.208565600657229NN

Label: 3, with a score of: 0.555066274129935
WordScorePoS
child0.10682408961305NN
persistent0.0307735781890304JJ
compare0.0307735781890304VB
growth0NN

Natural cubicB spline was used to model growth with special attention paid to children who became infected with C

Label: 8, with a score of: 0.571182773981668
WordScorePoS
natural0JJ
growth0.208565600657229NN
special0JJ
attention0NN
pay0.0695218668857431NN
child0.0452169560888236NN
infected0JJ

Label: 11, with a score of: 0.43487902703051
WordScorePoS
natural0.0229054731708393JJ
growth0NN
special0.0747035830159326JJ
attention0.08955644059472NN
pay0.0315914058171786NN
child0.0273960270556257NN
infected0JJ

Label: 10, with a score of: 0.418027030583842
WordScorePoS
natural0JJ
growth0.11178243319132NN
special0.0330412182586772JJ
attention0.0396106020715138NN
pay0.02794560829783NN
child0.0242343960710022NN
infected0JJ

parvum during the study

Label: 15, with a score of: 1
WordScorePoS
study0.0517339898971162NN

Age prior stunting food expenses number of diarrheal episodes persistent diarrhea water source and quality Regardless of presence of diarrhea EAggEC positive children showed significantly increased growth faltering more than

Label: 6, with a score of: 0.599511896259094
WordScorePoS
age0NN
stunt0NN
food0.0214003646985842NN
persistent0JJ
water0.556409482163189NN
source0.0613562156822703NN
quality0.0255958462813622NN
positive0JJ
child0.0255958462813622NN
significantly0RB
increase0.00905621749519576NN
growth0NN

Label: 2, with a score of: 0.481993071054939
WordScorePoS
age0.0365427838531249NN
stunt0.11668334276823NN
food0.292342270824999NN
persistent0JJ
water0NN
source0.0130963126055467NN
quality0.0109267235789154NN
positive0JJ
child0.0546336178945768NN
significantly0RB
increase0.0128868286091919NN
growth0.0252000451111224NN

Label: 12, with a score of: 0.34603773261671
WordScorePoS
age0NN
stunt0NN
food0.186896403054502NN
persistent0JJ
water0.186896403054502NN
source0NN
quality0.0203215381458133NN
positive0JJ
child0NN
significantly0RB
increase0.00958677785775002NN
growth0NN

Label: 8, with a score of: 0.271070292064179
WordScorePoS
age0.0252035516550537NN
stunt0NN
food0NN
persistent0JJ
water0NN
source0NN
quality0.030144637392549NN
positive0JJ
child0.0452169560888236NN
significantly0RB
increase0.00711043475673939NN
growth0.208565600657229NN

drop in score months after infection

Label: 3, with a score of: 1
WordScorePoS
infection0.122222546933424NN

EAggEC children without diarrhea showed intestinal inflammation and also had growth faltering

Label: 8, with a score of: 0.726737817045503
WordScorePoS
child0.0452169560888236NN
growth0.208565600657229NN

Label: 10, with a score of: 0.389501054946277
WordScorePoS
child0.0242343960710022NN
growth0.11178243319132NN

Label: 3, with a score of: 0.305904025432862
WordScorePoS
child0.10682408961305NN
growth0NN

in score

Label: 0, with a score of: 1

EAggEC remains dramatically underreported because showing its presence requires special techniques

Label: 8, with a score of: 0.579105498036682
WordScorePoS
remains0NNS
require0.104282800328615VB
special0JJ

of asymptomatic children in Brazil and

Label: 3, with a score of: 0.614417683772385
WordScorePoS
child0.10682408961305NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
child0.076326555629389NN

Label: 16, with a score of: 0.347374750571648
WordScorePoS
child0.0603953832457135NN

Label: 2, with a score of: 0.314234936000714
WordScorePoS
child0.0546336178945768NN

in India are carriers

Label: 0, with a score of: 1

parvum when acquired very early after birth and especially if child is stunted prior to infection likely leads to irreversible stunting C

Label: 3, with a score of: 0.687285874135575
WordScorePoS
acquire0.0307735781890304NN
birth0.0748292956291867NN
child0.10682408961305NN
stunt0NN
infection0.122222546933424NN
lead0.025518364538905NN

Label: 2, with a score of: 0.54957300216709
WordScorePoS
acquire0NN
birth0NN
child0.0546336178945768NN
stunt0.11668334276823NN
infection0NN
lead0NN

Label: 4, with a score of: 0.311842362425064
WordScorePoS
acquire0.0615662203253227NN
birth0NN
child0.076326555629389NN
stunt0NN
infection0NN
lead0.0255262687343935NN

parvum contributes to about centimeter height loss after year of infection

Label: 3, with a score of: 0.505997206534533
WordScorePoS
contribute0VB
height0NN
loss0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.49789825121505
WordScorePoS
contribute0VB
height0.120266261535276NN
loss0NN
infection0NN

Label: 14, with a score of: 0.432557690432826
WordScorePoS
contribute0.0815049608642826VB
height0NN
loss0.0229784274580034NN
infection0NN

Label: 12, with a score of: 0.423435432334847
WordScorePoS
contribute0.0554128417527413VB
height0NN
loss0.0468670845659596NN
infection0NN

continued TABLE A

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Number of Setting Children Age at Entry Brazil Lima and others Shantytown in northeastern Brazil months first ever persistent diarrheas found among children Bangladesh Alam and others Rural Matlab region Follow up Period Up to months Exposure Data Collection Anthropometric Data Collection Examination Quarterly times weekly by nurse extensive sampling of diarrheal pathogens from those who developed persistent diarrhea and matched controls Monthly months months Home visits by trained health workers every days and watery diarrhea and dysentery episodes recorded to establish period prevalence approximately Analysis Strategy Control Variables ok if blank Notes ok if blank Growth at Age sex feeding months before and practices after first ever persistent diarrhea episode was compared with that of children who did not develop persistent diarrhea

Label: 3, with a score of: 0.611183777036425
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
age0.0893142758861673NN
persistent0.0307735781890304JJ
rural0JJ
region0.124837844401518NN
period0NN
exposure0NN
datum0NN
collection0NN
time0.0127591822694525NN
match0.0407408489778079NN
control0.020806307400253NN
health0.191387734041787NN
worker0NN
day0.0175975629039954NN
record0NN
establish0VB
prevalence0.0407408489778079NN
approximately0RB
strategy0.0149758277542848NN
growth0NN
sex0NN
practice0NN
compare0.0307735781890304VB

Label: 1, with a score of: 0.497972038324836
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0450489732120807NN
develop0VB
country0NN
continue0VB
set0NN
age0.112994637345193NN
persistent0JJ
rural0JJ
region0.184259548107002NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
time0NN
match0NN
control0.0614198493690006NN
health0NN
worker0NN
day0.25973846344589NN
record0NN
establish0VB
prevalence0NN
approximately0RB
strategy0.0442083771593746NN
growth0.0519476926891779NN
sex0NN
practice0NN
compare0VB

Label: 2, with a score of: 0.287007572607808
WordScorePoS
study0NN
disease0NN
nutritional0.0583416713841148JJ
status0NN
child0.0546336178945768NN
develop0VB
country0NN
continue0VB
set0NN
age0.0365427838531249NN
persistent0JJ
rural0.148975141598503JJ
region0.0297950283197006NN
period0.0440683498519077NN
exposure0NN
datum0NN
collection0NN
time0.0182713919265625NN
match0NN
control0NN
health0NN
worker0NN
day0NN
record0NN
establish0VB
prevalence0NN
approximately0RB
strategy0NN
growth0.0252000451111224NN
sex0NN
practice0.0252000451111224NN
compare0VB

Label: 8, with a score of: 0.274364668254864
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0452169560888236NN
develop0VB
country0NN
continue0.0295821503613099VB
set0NN
age0.0252035516550537NN
persistent0JJ
rural0JJ
region0NN
period0NN
exposure0NN
datum0NN
collection0NN
time0NN
match0NN
control0NN
health0NN
worker0.121575732851624NN
day0.0347609334428716NN
record0NN
establish0VB
prevalence0NN
approximately0RB
strategy0.0295821503613099NN
growth0.208565600657229NN
sex0NN
practice0NN
compare0VB

Weight and height gains in no infection watery diarrhea and dysentery groups were compared by using month or year periods

Label: 3, with a score of: 0.641840124524855
WordScorePoS
height0NN
gain0NN
infection0.122222546933424NN
compare0.0307735781890304VB
period0NN

Label: 1, with a score of: 0.504533773114566
WordScorePoS
height0.120266261535276NN
gain0NN
infection0NN
compare0VB
period0NN

Label: 12, with a score of: 0.45059758097727
WordScorePoS
height0NN
gain0.0664302389559493NN
infection0NN
compare0VB
period0.0409791940864438NN

Age sex parental education household income land ownership baseline nutritional status diarrhea period prevalence Effect of Disease on Malnutrition Statistically significant shortterm growth faltering weight for age and height was found but there was no effect on height for age Cryptosporidium Giardia enteric adenoviruses and enterotoxigenic E

Label: 3, with a score of: 0.384369483297134
WordScorePoS
age0.0893142758861673NN
sex0NN
education0.0152605842304358NN
household0NN
income0NN
land0NN
ownership0NN
nutritional0JJ
status0NN
period0NN
prevalence0.0407408489778079NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
significant0.0127591822694525JJ
growth0NN
height0NN

Label: 10, with a score of: 0.374745416274284
WordScorePoS
age0.0202620733250388NN
sex0.064698038783335NN
education0.0121171980355011NN
household0.0330412182586772NN
income0.166475342664294NN
land0NN
ownership0NN
nutritional0JJ
status0.0488696285210061NN
period0NN
prevalence0NN
effect0NN
disease0NN
malnutrition0NN
significant0.0405241466500776JJ
growth0.11178243319132NN
height0NN

Label: 4, with a score of: 0.22334856430256
WordScorePoS
age0.0255262687343935NN
sex0NN
education0.244244978014045NN
household0NN
income0NN
land0NN
ownership0NN
nutritional0JJ
status0NN
period0NN
prevalence0NN
effect0NN
disease0NN
malnutrition0NN
significant0JJ
growth0NN
height0NN

Label: 8, with a score of: 0.208328505340512
WordScorePoS
age0.0252035516550537NN
sex0NN
education0.0150723186962745NN
household0NN
income0NN
land0NN
ownership0NN
nutritional0JJ
status0NN
period0NN
prevalence0NN
effect0NN
disease0NN
malnutrition0NN
significant0JJ
growth0.208565600657229NN
height0NN

Label: 1, with a score of: 0.637082172659369
WordScorePoS
age0.112994637345193NN
sex0NN
education0.0225244866060403NN
household0NN
income0.0442083771593746NN
land0.0319966432858631NN
ownership0.0736315832425121NN
nutritional0JJ
status0NN
period0NN
prevalence0NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
significant0.0376648791150643JJ
growth0.0519476926891779NN
height0.120266261535276NN

Label: 2, with a score of: 0.349333076832092
WordScorePoS
age0.0365427838531249NN
sex0NN
education0NN
household0.0297950283197006NN
income0.0643370113878709NN
land0.0465651203624806NN
ownership0NN
nutritional0.0583416713841148JJ
status0NN
period0.0440683498519077NN
prevalence0NN
effect0.0440683498519077NN
disease0NN
malnutrition0.0357189919948307NN
significant0JJ
growth0.0252000451111224NN
height0NN

coli were significantly associated with persistent diarrhea even partial breastfeeding was found to be protective against diarrheal disease persistent diarrhea was strongly associated with lack of toilet pit or flush

Label: 3, with a score of: 0.761718948100618
WordScorePoS
significantly0RB
persistent0.0307735781890304JJ
disease0.215415047323213NN
lack0NN
toilet0NN

Label: 6, with a score of: 0.530699395008612
WordScorePoS
significantly0RB
persistent0JJ
disease0.103230094596636NN
lack0.0214003646985842NN
toilet0.0683326727248364NN

Matlab is special observation region where many observational epidemiological studies are carried out by the International Centre for Diarrhoeal Disease Research

Label: 3, with a score of: 0.710288775759343
WordScorePoS
special0JJ
region0.124837844401518NN
study0NN
international0JJ
centre0NN
diarrhoeal0NN
disease0.215415047323213NN
research0.0175975629039954NN

Label: 1, with a score of: 0.376278027864503
WordScorePoS
special0JJ
region0.184259548107002NN
study0NN
international0.00531301439641424JJ
centre0NN
diarrhoeal0NN
disease0NN
research0NN

Label: 6, with a score of: 0.415789695517905
WordScorePoS
special0.0348974218717993JJ
region0NN
study0NN
international0.00301873916506525JJ
centre0NN
diarrhoeal0.0683326727248364NN
disease0.103230094596636NN
research0NN

Strong evidence was found that watery diarrhea but especially dysentery causes growth faltering in the short and long terms

Label: 10, with a score of: 0.758945640225219
WordScorePoS
strong0.0488696285210061JJ
evidence0.12939607756667NN
growth0.11178243319132NN
term0.0396106020715138NN

Label: 8, with a score of: 0.480163070062372
WordScorePoS
strong0JJ
evidence0NN
growth0.208565600657229NN
term0NN

Label: 17, with a score of: 0.344856751126553
WordScorePoS
strong0JJ
evidence0NN
growth0NN
term0.149793392961411NN

Watery diarrhea and dysentery resulted in grams

Label: 6, with a score of: 1
WordScorePoS
result0.0683326727248364NN

centimeters and grams

Label: 0, with a score of: 1

centimeters of statistically significant growth faltering respectively in year period

Label: 8, with a score of: 0.71251407973217
WordScorePoS
significant0JJ
growth0.208565600657229NN
period0NN

Label: 10, with a score of: 0.520318701793963
WordScorePoS
significant0.0405241466500776JJ
growth0.11178243319132NN
period0NN

Label: 1, with a score of: 0.30613974179025
WordScorePoS
significant0.0376648791150643JJ
growth0.0519476926891779NN
period0NN

Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Pakistan Fikree Rahbar and Berendes Urban squatter settlements of Karachi pregnant n

Label: 11, with a score of: 0.562211252214376
WordScorePoS
country0NN
study0NN
set0NN
child0.0273960270556257NN
age0NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
urban0.27622591898666JJ
settlement0.146277152173395NN
pregnant0JJ

Label: 1, with a score of: 0.47978384498783
WordScorePoS
country0NN
study0NN
set0NN
child0.0450489732120807NN
age0.112994637345193NN
period0NN
exposure0.120266261535276NN
datum0NN
collection0NN
strategy0.0442083771593746NN
control0.0614198493690006NN
urban0JJ
settlement0NN
pregnant0JJ

women initially recruited newborns recruited for follow up Children visited at one three six nine twelve eighteen and twentyfour months Previous month recall acute lower and month respiratory infection or visits weeks diarrhea during visits for child to be classified as having diarrhea he or she had to have diarrhea in at least of contact times that is exposure relied on the number of episodes Logistic regression technique used to estimate relative risk of becoming malnourished when child was exposed to infections Socioeconomic indicators income house water supply maternal indicators education weight parity first child feeding practice breast or nonhuman milk Brazil Moore and others Shantytown in northeastern Brazil months years months Home visits or times Quarterly weekly to establish clinical period prevalence of diarrhea and stool samples to establish enteric pathogens ova and parasites Repeat measure modeling was used to explain growth faltering caused by early childhood diarrhea and intestinal helminths

Label: 3, with a score of: 0.549807775118837
WordScorePoS
woman0.0381514605760894NN
newborn0.0407408489778079JJ
child0.10682408961305NN
previous0JJ
recall0NN
infection0.122222546933424NN
time0.0127591822694525NN
exposure0NN
rely0VB
estimate0.059903311017139NN
relative0JJ
risk0.0703902516159815NN
income0NN
water0.0382775468083574NN
supply0NN
maternal0.184641469134183JJ
education0.0152605842304358NN
parity0NN
practice0NN
establish0VB
period0NN
prevalence0.0407408489778079NN
measure0NN
growth0NN
cause0NN
childhood0NN

Label: 4, with a score of: 0.351251740114078
WordScorePoS
woman0.0610612445035112NN
newborn0JJ
child0.076326555629389NN
previous0JJ
recall0NN
infection0NN
time0NN
exposure0NN
rely0VB
estimate0.0299609328954485NN
relative0JJ
risk0NN
income0NN
water0NN
supply0.0352060273355634NN
maternal0JJ
education0.244244978014045NN
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practice0NN
establish0VB
period0NN
prevalence0NN
measure0NN
growth0NN
cause0NN
childhood0.0815069365350084NN

Label: 6, with a score of: 0.338883979819065
WordScorePoS
woman0.0127979231406811NN
newborn0JJ
child0.0255958462813622NN
previous0JJ
recall0NN
infection0NN
time0NN
exposure0NN
rely0VB
estimate0NN
relative0JJ
risk0NN
income0NN
water0.556409482163189NN
supply0.0590310971343993NN
maternal0JJ
education0NN
parity0NN
practice0NN
establish0VB
period0NN
prevalence0NN
measure0NN
growth0NN
cause0NN
childhood0NN

Label: 10, with a score of: 0.28290567078019
WordScorePoS
woman0.0242343960710022NN
newborn0JJ
child0.0242343960710022NN
previous0JJ
recall0NN
infection0NN
time0.0607862199751165NN
exposure0NN
rely0VB
estimate0NN
relative0JJ
risk0NN
income0.166475342664294NN
water0NN
supply0NN
maternal0.0488696285210061JJ
education0.0121171980355011NN
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practice0.02794560829783NN
establish0VB
period0NN
prevalence0NN
measure0NN
growth0.11178243319132NN
cause0NN
childhood0NN

Label: 8, with a score of: 0.224717798062708
WordScorePoS
woman0.0452169560888236NN
newborn0JJ
child0.0452169560888236NN
previous0JJ
recall0NN
infection0NN
time0NN
exposure0NN
rely0VB
estimate0NN
relative0JJ
risk0NN
income0NN
water0NN
supply0NN
maternal0JJ
education0.0150723186962745NN
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practice0NN
establish0VB
period0NN
prevalence0NN
measure0.0347609334428716NN
growth0.208565600657229NN
cause0NN
childhood0NN

Label: 5, with a score of: 0.218954633223938
WordScorePoS
woman0.221979360474357NN
newborn0JJ
child0.0170753354211044NN
previous0JJ
recall0NN
infection0NN
time0NN
exposure0NN
rely0VB
estimate0NN
relative0JJ
risk0NN
income0NN
water0NN
supply0NN
maternal0JJ
education0.0512260062633133NN
parity0.0911713013253052NN
practice0.0393804437159645NN
establish0VB
period0NN
prevalence0NN
measure0NN
growth0NN
cause0NN
childhood0NN

Label: 12, with a score of: 0.216040761905556
WordScorePoS
woman0NN
newborn0JJ
child0NN
previous0JJ
recall0NN
infection0NN
time0.0169905820958638NN
exposure0NN
rely0.0332151194779746VB
estimate0.0199423462679015NN
relative0JJ
risk0NN
income0NN
water0.186896403054502NN
supply0.0703006268489394NN
maternal0JJ
education0.0101607690729067NN
parity0NN
practice0.0703006268489394NN
establish0VB
period0.0409791940864438NN
prevalence0NN
measure0NN
growth0NN
cause0NN
childhood0NN

Nutritional status in infancy other parasitic infections diarrhea in later childhood socioeconomic status years

Label: 3, with a score of: 0.611089275322339
WordScorePoS
nutritional0JJ
status0NN
infection0.122222546933424NN
childhood0NN

months median Morbidity recorded during weekly visits period prevalence

Label: 0, with a score of: 1

Natural growth history of children with persistent diarrhea was studied

Label: 8, with a score of: 0.629725432432375
WordScorePoS
natural0JJ
growth0.208565600657229NN
history0NN
child0.0452169560888236NN
persistent0JJ
study0NN

Label: 3, with a score of: 0.341429103596968
WordScorePoS
natural0JJ
growth0NN
history0NN
child0.10682408961305NN
persistent0.0307735781890304JJ
study0NN

Label: 10, with a score of: 0.337506476897091
WordScorePoS
natural0JJ
growth0.11178243319132NN
history0NN
child0.0242343960710022NN
persistent0JJ
study0NN

Label: 1, with a score of: 0.334143531197341
WordScorePoS
natural0.0376648791150643JJ
growth0.0519476926891779NN
history0NN
child0.0450489732120807NN
persistent0JJ
study0NN

Guinea Bissau Peri Valentinerurban Branth and setting others Monthly knee toheel length and weight total length quarterly Notes ok if blank Effect of Disease on Malnutrition Intrauterine growth restriction was the strongest predictor of stunting and wasting water supply and diarrheal episodes predicted stunting but risk factors for wasting were limited only to socioeconomic status

Label: 6, with a score of: 0.615714952905202
WordScorePoS
perus0NN
set0NN
total0.0295155485671997NN
effect0NN
disease0.103230094596636NN
malnutrition0.041835863322702NN
growth0NN
restriction0NN
stunt0NN
waste0NN
water0.556409482163189NN
supply0.0590310971343993NN
predict0VB
risk0NN
limited0JJ
status0NN

Label: 12, with a score of: 0.452910626943059
WordScorePoS
perus0NN
set0NN
total0.0468670845659596NN
effect0NN
disease0NN
malnutrition0NN
growth0NN
restriction0NN
stunt0NN
waste0.138532104381853NN
water0.186896403054502NN
supply0.0703006268489394NN
predict0VB
risk0NN
limited0JJ
status0NN

Label: 3, with a score of: 0.252578576849259
WordScorePoS
perus0NN
set0NN
total0NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
growth0NN
restriction0NN
stunt0NN
waste0NN
water0.0382775468083574NN
supply0NN
predict0VB
risk0.0703902516159815NN
limited0JJ
status0NN

Label: 8, with a score of: 0.162548568321166
WordScorePoS
perus0NN
set0NN
total0NN
effect0NN
disease0NN
malnutrition0NN
growth0.208565600657229NN
restriction0NN
stunt0NN
waste0NN
water0NN
supply0NN
predict0VB
risk0NN
limited0JJ
status0NN

Stunting rose from

Label: 2, with a score of: 0.726905133530343
WordScorePoS
stunt0.11668334276823NN
rise0.0214456704626236NN

Label: 13, with a score of: 0.636311934029118
WordScorePoS
stunt0NN
rise0.120914181920259NN

at months to

Label: 0, with a score of: 1

at months which the authors noted could be due to feeding practices and exposure to more contaminated environment than found in Western countries breastfeeding was protective

Label: 12, with a score of: 0.533943110316962
WordScorePoS
due0.0234335422829798JJ
practice0.0703006268489394NN
exposure0NN
contaminate0VB
environment0.079769385071606NN
western0JJ
country0NN

Label: 1, with a score of: 0.529974471017029
WordScorePoS
due0.0519476926891779JJ
practice0NN
exposure0.120266261535276NN
contaminate0VB
environment0NN
western0JJ
country0NN

Results represent best case scenario as this shantytown has been subject to substantial nutritional interventions Ascaris infections were treated

Label: 3, with a score of: 0.676764373820803
WordScorePoS
result0NN
represent0VB
scenario0NN
substantial0JJ
nutritional0JJ
intervention0.0407408489778079NN
infection0.122222546933424NN

Label: 6, with a score of: 0.498126239814742
WordScorePoS
result0.0683326727248364NN
represent0.0516150472983178VB
scenario0NN
substantial0JJ
nutritional0JJ
intervention0NN
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Study found early childhood diarrhea and intestinal helminths were independently associated with profound and lasting linear growth faltering

Label: 8, with a score of: 0.746482557895836
WordScorePoS
study0NN
childhood0NN
profound0JJ
last0JJ
growth0.208565600657229NN

Label: 10, with a score of: 0.400083409697144
WordScorePoS
study0NN
childhood0NN
profound0JJ
last0JJ
growth0.11178243319132NN

By age an average child experiencing

Label: 13, with a score of: 0.468107527242146
WordScorePoS
age0NN
average0.1656430212089NN
child0NN
experience0.0335649154577099NN

Label: 10, with a score of: 0.449067726163605
WordScorePoS
age0.0202620733250388NN
average0.146608885563018NN
child0.0242343960710022NN
experience0NN

Label: 3, with a score of: 0.51950689909059
WordScorePoS
age0.0893142758861673NN
average0NN
child0.10682408961305NN
experience0.0249430985430622NN

Label: 1, with a score of: 0.37137779233264
WordScorePoS
age0.112994637345193NN
average0NN
child0.0450489732120807NN
experience0NN

diarrhea episodes before age had

Label: 1, with a score of: 0.729188688443444
WordScorePoS
age0.112994637345193NN

Label: 3, with a score of: 0.576372129004236
WordScorePoS
age0.0893142758861673NN

centimeter growth deficit early helminth infection added

Label: 8, with a score of: 0.852380097267993
WordScorePoS
growth0.208565600657229NN
infection0NN
add0.0804764811724088VB

Label: 3, with a score of: 0.360432175771753
WordScorePoS
growth0NN
infection0.122222546933424NN
add0VB

Label: 10, with a score of: 0.329644461018757
WordScorePoS
growth0.11178243319132NN
infection0NN
add0VB

centimeters to this deficit

Label: 0, with a score of: 1

Children were examined by physician and offered fluid therapy and antibiotics according to WHO guidelines breast feeding was encouraged half of children received nutritional interventions

Label: 3, with a score of: 0.742513851161169
WordScorePoS
child0.10682408961305NN
offer0NN
therapy0.0407408489778079NN
guideline0NN
encouraged0JJ
receive0.0814816979556159VB
nutritional0JJ
intervention0.0407408489778079NN

Label: 2, with a score of: 0.417335275103221
WordScorePoS
child0.0546336178945768NN
offer0.0440683498519077NN
therapy0NN
guideline0NN
encouraged0JJ
receive0VB
nutritional0.0583416713841148JJ
intervention0NN

Authors found that the negative effect of persistent diarrhea on linear growth was sustained during the follow up period but some catch up in weight gain occurred in the treatment group

Label: 8, with a score of: 0.514417472175208
WordScorePoS
effect0NN
persistent0JJ
growth0.208565600657229NN
sustained0JJ
period0NN
gain0NN
occur0VB
treatment0NN

Label: 9, with a score of: 0.473273847986211
WordScorePoS
effect0.0454743001434393NN
persistent0JJ
growth0.0260040237236563NN
sustained0.120405991343299JJ
period0NN
gain0NN
occur0VB
treatment0NN

continued TABLE A

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Setting Number of Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition Egypt Wierzba and others Periurban Alexandria where malnutrition rates remain below months Twice weekly home visits Approximately quarterly to establish number of diarrhea episodes Study analyzed odds ratio to fall below standard deviations greater than or equal to episode versus none during interval additional special emphasis was placed on month periods where diarrhea occurs in the first half to study catchup growth in disease free environment

Label: 3, with a score of: 0.625415186465787
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
effect0NN
malnutrition0NN
rate0.0433561464459019NN
remain0VB
approximately0RB
establish0VB
ratio0.0615471563780609NN
fall0.123094312756122NN
standard0NN
equal0JJ
additional0JJ
special0JJ
occur0.0307735781890304VB
growth0NN
free0JJ
environment0NN

Label: 8, with a score of: 0.272645707017096
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0452169560888236NN
develop0VB
country0NN
continue0.0295821503613099VB
set0NN
age0.0252035516550537NN
period0NN
exposure0NN
datum0NN
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strategy0.0295821503613099NN
control0NN
effect0NN
malnutrition0NN
rate0NN
remain0.049270765107907VB
approximately0RB
establish0VB
ratio0NN
fall0NN
standard0NN
equal0.0504071033101074JJ
additional0JJ
special0JJ
occur0VB
growth0.208565600657229NN
free0JJ
environment0.0591643007226199NN

Age socioeconomic status mother education days of exclusive breastfeeding presence of sanitary latrine Oral rehydration therapy was provided and referrals for hospital care were made when needed exclusive breastfeeding was ascertained during visits

Label: 3, with a score of: 0.612774924374241
WordScorePoS
age0.0893142758861673NN
status0NN
mother0.162963395911232NN
education0.0152605842304358NN
day0.0175975629039954NN
latrine0NN
therapy0.0407408489778079NN
care0.104031537001265NN

Label: 1, with a score of: 0.563385242381714
WordScorePoS
age0.112994637345193NN
status0NN
mother0NN
education0.0225244866060403NN
day0.25973846344589NN
latrine0NN
therapy0NN
care0NN

Label: 4, with a score of: 0.443853172099062
WordScorePoS
age0.0255262687343935NN
status0NN
mother0NN
education0.244244978014045NN
day0NN
latrine0NN
therapy0NN
care0.0416255041156371NN

<

Label: 0, with a score of: 1

reduction of the standard zscore when periods extended to months and diarrhea occurred during the first half of the period the association remained negative in models but was not statistically significant authors noted that catch up may compensate growth faltering but those with diarrhea in the first half when compared to nondiseased individuals had slower growth velocity >

Label: 8, with a score of: 0.623360771689472
WordScorePoS
reduction0NN
standard0NN
period0NN
extend0VB
occur0VB
remain0.049270765107907VB
significant0JJ
growth0.208565600657229NN
compare0VB
individual0JJ

Label: 10, with a score of: 0.642417180129695
WordScorePoS
reduction0.0475643836183697NN
standard0NN
period0NN
extend0.064698038783335VB
occur0VB
remain0.0396106020715138VB
significant0.0405241466500776JJ
growth0.11178243319132NN
compare0VB
individual0.064698038783335JJ

Peru Checkley and others Periurban Lima months months CAR error term modeling was used based on child days with days of diarrhea

Label: 1, with a score of: 0.864324939621917
WordScorePoS
car0NN
term0NN
base0.0442083771593746NN
child0.0450489732120807NN
day0.25973846344589NN

Label: 17, with a score of: 0.238226988781265
WordScorePoS
car0NN
term0.149793392961411NN
base0.017987180284335NN
child0NN
day0NN

Age sex breastfeeding water supply and sanitation maternal stature Study does not specifically mention but as children were attended daily case management must have been included

Label: 6, with a score of: 0.833591284238607
WordScorePoS
age0NN
sex0NN
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
maternal0JJ
study0NN
child0.0255958462813622NN
attend0VB
daily0RB
management0.0428007293971684NN
include0VB

Label: 3, with a score of: 0.373826095835782
WordScorePoS
age0.0893142758861673NN
sex0NN
water0.0382775468083574NN
supply0NN
sanitation0.0249430985430622NN
maternal0.184641469134183JJ
study0NN
child0.10682408961305NN
attend0VB
daily0RB
management0.0127591822694525NN
include0VB

Label: 12, with a score of: 0.238309151368351
WordScorePoS
age0NN
sex0NN
water0.186896403054502NN
supply0.0703006268489394NN
sanitation0NN
maternal0JJ
study0NN
child0NN
attend0VB
daily0RB
management0.0339811641917276NN
include0VB

Diarrheal period prevalence in the cohort explained of the growth retardation and the average child was

Label: 10, with a score of: 0.587045488940369
WordScorePoS
period0NN
prevalence0NN
growth0.11178243319132NN
average0.146608885563018NN
child0.0242343960710022NN

Label: 8, with a score of: 0.527134996196622
WordScorePoS
period0NN
prevalence0NN
growth0.208565600657229NN
average0NN
child0.0452169560888236NN

Label: 13, with a score of: 0.344059239037154
WordScorePoS
period0NN
prevalence0NN
growth0NN
average0.1656430212089NN
child0NN

Label: 3, with a score of: 0.306509022291409
WordScorePoS
period0NN
prevalence0.0407408489778079NN
growth0NN
average0NN
child0.10682408961305NN

centimeters shorter than international peers diarrhea especially before age months predisposes children to irreversible stunting with extensive resolution of collected data and elaborate modeling this study showed decelerations on linear growth later in life as result of early infancy exposure to diarrhea cm difference in maternal stature corresponded to

Label: 3, with a score of: 0.557006536793077
WordScorePoS
international0JJ
age0.0893142758861673NN
child0.10682408961305NN
stunt0NN
datum0NN
study0NN
growth0NN
life0.0250390290383647NN
result0NN
exposure0NN
maternal0.184641469134183JJ

Label: 8, with a score of: 0.404773661341164
WordScorePoS
international0.00355521737836969JJ
age0.0252035516550537NN
child0.0452169560888236NN
stunt0NN
datum0NN
study0NN
growth0.208565600657229NN
life0.0123650647908625NN
result0NN
exposure0NN
maternal0JJ

Label: 1, with a score of: 0.485950201177579
WordScorePoS
international0.00531301439641424JJ
age0.112994637345193NN
child0.0450489732120807NN
stunt0NN
datum0NN
study0NN
growth0.0519476926891779NN
life0.0184786920895884NN
result0NN
exposure0.120266261535276NN
maternal0JJ

cm height deficit at months Active surveillance of Monthly diarrhea to establish clinical period prevalence and stool samples to establish pathogens Country study Number of Setting Children Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition High attendance rates died and only dropped were feature throughout the study during the first prenatal visit mothers were offered medical examinations and laboratory measurements

Label: 3, with a score of: 0.602113908664981
WordScorePoS
height0NN
active0JJ
establish0VB
period0NN
prevalence0.0407408489778079NN
country0NN
study0NN
set0NN
child0.10682408961305NN
age0.0893142758861673NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
effect0NN
disease0.215415047323213NN
malnutrition0NN
rate0.0433561464459019NN
die0.0748292956291867VB
feature0NN
mother0.162963395911232NN
offer0NN
measurement0NN

Label: 1, with a score of: 0.50239421277245
WordScorePoS
height0.120266261535276NN
active0JJ
establish0VB
period0NN
prevalence0NN
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study0NN
set0NN
child0.0450489732120807NN
age0.112994637345193NN
exposure0.120266261535276NN
datum0NN
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strategy0.0442083771593746NN
control0.0614198493690006NN
effect0NN
disease0NN
malnutrition0.0736315832425121NN
rate0.0639932865717261NN
die0VB
feature0NN
mother0NN
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Infancy disease episodes were strongest determinants of growth faltering followed by intrauterine growth restriction using proxy measure disease episodes remained strong predictors of underweight and wasting but adjustment with intrauterine growth restriction which remained highly significant predictor of stunting dropped infancy disease episodes from

Label: 8, with a score of: 0.58814786622421
WordScorePoS
disease0NN
growth0.208565600657229NN
restriction0NN
measure0.0347609334428716NN
remain0.049270765107907VB
strong0JJ
waste0NN
highly0RB
significant0JJ
stunt0NN

Label: 3, with a score of: 0.5106618737132
WordScorePoS
disease0.215415047323213NN
growth0NN
restriction0NN
measure0NN
remain0VB
strong0JJ
waste0NN
highly0RB
significant0.0127591822694525JJ
stunt0NN

Label: 12, with a score of: 0.107348406362511
WordScorePoS
disease0NN
growth0NN
restriction0NN
measure0NN
remain0VB
strong0JJ
waste0.138532104381853NN
highly0RB
significant0JJ
stunt0NN

adjustment with itself

Label: 0, with a score of: 1

Malawi Maleta Rural covered and others of deliveries in the catchmen area months months Data on infant feeding and morbidity collected monthly until months no morbidity data collected thereafter Monthly until months thereafter quarterly until months Odds ratio of falling below severe standard deviations underweight and stunting and moderate

Label: 2, with a score of: 0.776215343702164
WordScorePoS
rural0.148975141598503JJ
cover0NN
datum0NN
infant0.0583416713841148NN
ratio0NN
fall0.0440683498519077NN
standard0NN
stunt0.11668334276823NN

standard deviations wasting during follow up using greater than or equal to

Label: 12, with a score of: 0.714849633229622
WordScorePoS
standard0.0409791940864438NN
waste0.138532104381853NN
equal0JJ

Label: 5, with a score of: 0.454813997405448
WordScorePoS
standard0NN
waste0NN
equal0.114211783066808JJ

disease episodes per month in infancy as the explanatory variable

Label: 3, with a score of: 0.9017990870513
WordScorePoS
disease0.215415047323213NN

Label: 6, with a score of: 0.432155535187786
WordScorePoS
disease0.103230094596636NN

Average size at months distance to health center gestation less than weeks maternal HIV delivery by trained assistant or not sex Tanzania Villamor and others months months Morbidity episodes diarrhea on average

Label: 3, with a score of: 0.808438710622104
WordScorePoS
average0NN
size0NN
health0.191387734041787NN
maternal0.184641469134183JJ
hiv0.448149338755887NN
sex0NN

Label: 10, with a score of: 0.477621180665922
WordScorePoS
average0.146608885563018NN
size0.0396106020715138NN
health0.0405241466500776NN
maternal0.0488696285210061JJ
hiv0NN
sex0.064698038783335NN

Label: 13, with a score of: 0.324959274420771
WordScorePoS
average0.1656430212089NN
size0NN
health0NN
maternal0JJ
hiv0NN
sex0NN

episodes per child per year established during monthly visits using pictorial diary blood samples from all children at hospital blood collected from subsamples later Monthly Mixed effect models were estimated to see how much HIV infection causes growth faltering adjusted various morbidity effects on growth faltering were also estimated

Label: 3, with a score of: 0.776125329432739
WordScorePoS
child0.10682408961305NN
establish0VB
effect0NN
estimate0.059903311017139NN
hiv0.448149338755887NN
infection0.122222546933424NN
growth0NN

Label: 8, with a score of: 0.435851415548603
WordScorePoS
child0.0452169560888236NN
establish0VB
effect0NN
estimate0NN
hiv0NN
infection0NN
growth0.208565600657229NN

Age index episodes HIV maternal education treatment arm anemia Urban Dar es Salaam hospital children admitted recruited to receive series of vitamin shots HIV was strongly associated especially in the to month period with growth faltering

Label: 3, with a score of: 0.894118023781019
WordScorePoS
age0.0893142758861673NN
hiv0.448149338755887NN
maternal0.184641469134183JJ
education0.0152605842304358NN
treatment0.0624189222007589NN
arm0NN
urban0JJ
child0.10682408961305NN
receive0.0814816979556159VB
period0NN
growth0NN

Label: 4, with a score of: 0.215460051365405
WordScorePoS
age0.0255262687343935NN
hiv0NN
maternal0JJ
education0.244244978014045NN
treatment0NN
arm0NN
urban0JJ
child0.076326555629389NN
receive0VB
period0NN
growth0NN

Label: 11, with a score of: 0.189017091817646
WordScorePoS
age0NN
hiv0NN
maternal0JJ
education0NN
treatment0NN
arm0NN
urban0.27622591898666JJ
child0.0273960270556257NN
receive0VB
period0NN
growth0NN

Label: 8, with a score of: 0.183063409740076
WordScorePoS
age0.0252035516550537NN
hiv0NN
maternal0JJ
education0.0150723186962745NN
treatment0NN
arm0NN
urban0JJ
child0.0452169560888236NN
receive0VB
period0NN
growth0.208565600657229NN

centimeters and

Label: 0, with a score of: 1

kilograms whereas diarrhea though it decreased length in the month period by

Label: 11, with a score of: 0.772212094556055
WordScorePoS
decrease0.0731385760866977NN
period0NN

centimeters did not show linear dose response dysentery appeared to be related to lower weight gain

Label: 6, with a score of: 0.609933764439855
WordScorePoS
response0NN
related0.0524959536790166JJ
gain0.041835863322702NN

kilograms in children in the month group

Label: 3, with a score of: 0.614417683772385
WordScorePoS
child0.10682408961305NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
child0.076326555629389NN

Label: 16, with a score of: 0.347374750571648
WordScorePoS
child0.0603953832457135NN

Label: 2, with a score of: 0.314234936000714
WordScorePoS
child0.0546336178945768NN

continued TABLE A

Label: 11, with a score of: 0.621824792049266
WordScorePoS
continue0.0537696560159885VB

Label: 13, with a score of: 0.466108220381242
WordScorePoS
continue0.0403047273067529VB

Label: 5, with a score of: 0.387569587219377
WordScorePoS
continue0.0335134328085675VB

Label: 8, with a score of: 0.342105861553622
WordScorePoS
continue0.0295821503613099VB

Cohort Follow up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries continued Country study Number of Setting Children Brazil Prado and others Urban Colombia Alvarado and others Remote rural AfroColombian village Guapi Age at Entry Follow up Period Exposure Data Collection Anthropometric Data Collection Analysis Strategy Control Variables ok if blank Notes ok if blank Effect of Disease on Malnutrition months months Every months Stool samples collected once during the first year but diarrhea symptoms probed twice week to establish period prevalence Variance and covariance were analyzed

Label: 3, with a score of: 0.593198423197973
WordScorePoS
study0NN
disease0.215415047323213NN
nutritional0JJ
status0NN
child0.10682408961305NN
develop0VB
country0NN
continue0VB
set0NN
urban0JJ
rural0JJ
age0.0893142758861673NN
period0NN
exposure0NN
datum0NN
collection0NN
strategy0.0149758277542848NN
control0.020806307400253NN
effect0NN
malnutrition0NN
establish0VB
prevalence0.0407408489778079NN

Label: 2, with a score of: 0.381439752836288
WordScorePoS
study0NN
disease0NN
nutritional0.0583416713841148JJ
status0NN
child0.0546336178945768NN
develop0VB
country0NN
continue0VB
set0NN
urban0JJ
rural0.148975141598503JJ
age0.0365427838531249NN
period0.0440683498519077NN
exposure0NN
datum0NN
collection0NN
strategy0NN
control0NN
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
establish0VB
prevalence0NN

Label: 11, with a score of: 0.309030776542251
WordScorePoS
study0NN
disease0NN
nutritional0JJ
status0NN
child0.0273960270556257NN
develop0VB
country0NN
continue0.0537696560159885VB
set0NN
urban0.27622591898666JJ
rural0.0373517915079663JJ
age0NN
period0NN
exposure0NN
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strategy0NN
control0NN
effect0NN
malnutrition0NN
establish0VB
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Sex age house floods during rain presence of rubbish near house duration of interval between measurements prevalence of diarrhea during that interval and intensity of infection Ascaris lumbricoides and Trichuris trichiura baseline anthropometry All children were treated to eradicate Giardia lamblia Ascaris lumbricoides and Trichuris trichiura during the first year of study

Label: 3, with a score of: 0.699942535427926
WordScorePoS
sex0NN
age0.0893142758861673NN
flood0NN
measurement0NN
prevalence0.0407408489778079NN
intensity0NN
infection0.122222546933424NN
child0.10682408961305NN
eradicate0.020806307400253VB
study0NN

Both symptomatic and asymptomatic Giardia infections had lasting effect on linear growth investigators were able to exclude reverse causality that is the mere susceptibility of the malnourished to Giardia infection as the explanation for the short stature of those infected by showing the effect on stunting with lag

Label: 8, with a score of: 0.453315103206594
WordScorePoS
infection0NN
last0JJ
effect0NN
growth0.208565600657229NN
reverse0NN
infected0JJ
stunt0NN

months Morbidity recorded Approximate by mothers recorded daily month intervals diarrhea cough fever or other nonspecific symptoms data collected by health worker weekly Hierarchical linear model was used to model time varying and fixed variables on weight and height gain

Label: 3, with a score of: 0.733294496933237
WordScorePoS
record0NN
mother0.162963395911232NN
daily0RB
datum0NN
health0.191387734041787NN
worker0NN
time0.0127591822694525NN
height0NN
gain0NN

Initial status gender preterm or term delivery maternal height mother education child age breastfeeding Continued breastfeeding more than months was widespread at months women increased breastfeeding during disease episodes unlike in many other cultures

Label: 3, with a score of: 0.634560284554817
WordScorePoS
status0NN
gender0.0175975629039954NN
term0NN
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WordScorePoS
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WordScorePoS
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Label: 17, with a score of: 0.170960391999555
WordScorePoS
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Study showed the substantial protective effect of breastfeeding which diminished with increasing socioeconomic status and which probably mitigated growth faltering caused by diarrhea morbidity respiratory infections were associated with growth faltering

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WordScorePoS
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months Source Compiled by World Bank team

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source0.0130963126055467NN
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Not fixed cohort because surveys were made in an open cohort

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WordScorePoS
survey0.064698038783335NN

P E D X Review of Studies on Nutritional Status and Education THIS APPENDIX REVIEWS RECENT LITERATURE on the effects of low height for age in childhood on subsequent educational outcomes

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One group of studies investigates the effects of malnutrition on cognitive function measured in terms of IQ scores or performance on cognitive tests Fishman and others

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A second group assesses the effect on educational outcomes

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This appendix concentrates on the latter

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Several longitudinal studies have recently become available that investigate the effect of early childhood malnutrition on educational outcomes table B

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outcome0.0416255041156371NN

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WordScorePoS
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The majority of longitudinal studies use stunting low height for age score or HAZ as measure of nutritional status because HAZ is considered an indicator of chronic nutritional deficit

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WordScorePoS
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These studies use data that follow children over time usually from birth well into primary or secondary schooling and contain various anthropometric schooling and socioeconomic status indicators

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WordScorePoS
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WordScorePoS
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WordScorePoS
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Such longitudinal data have important advantages in terms of investigating causal relationships between malnutrition and educational outcomes compared with the cross sectional data often used in earlier studies

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WordScorePoS
datum0.0739231123597559NN
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Grantham McGregor and others present an analysis of longitudinal data of more than male youths in Brazil

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WordScorePoS
datum0NN
youth0.124876512346911NN

Label: 17, with a score of: 0.528816158468918
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WordScorePoS
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They find that stunting HAZ < in early childhood is associated with loss of

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WordScorePoS
stunt0.11668334276823NN
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loss0NN

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stunt0NN
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years of grade attainment by age

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age0.112994637345193NN

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Using the stratified data in their study Grantham McGregor and others TABLE B

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Studies of the Effects of Malnutrition on Educational Outcomes Source Country Data Children School grade attainment Grantham McGregor Brazil and others Longitudinal males HAZ < HAZ to versus > Maluccio Hoddinott and Behrman Daniels and Adair Longitudinal Longitudinal Nutrition supplement HAZ < HAZ to HAZ Guatemala rural Philippines Cebu Indicator Alderman and others Uganda rural Learning productivity grade equivalents Behrman and others Guatemala rural Glewwe Jacoby and Philippines Cebu King Longitudinal HAZ Longitudinal Longitudinal HAZ HAZ HAZ <

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School dropout and grade repetition Maluccio Hoddinott Guatemala rural and Behrman Walker and others Jamaica Kingston Longitudinal Longitudinal Nutrition supplement HAZ < versus HAZ > Impact on Education

Label: 4, with a score of: 0.728933849900277
WordScorePoS
school0.208127520578185NN
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education0.244244978014045NN

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WordScorePoS
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lower grade attainment

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lower grade attainmenta

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higher grade attainment women

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WordScorePoS
woman0.221979360474357NN

lower grade attainment

Label: 0, with a score of: 1

lower grade attainment

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to versus > lower grade attainment

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lower grade attainment per HAZ decline

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school year equivalent per HAZ

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WordScorePoS
school0.208127520578185NN
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Label: 5, with a score of: 0.362107445455348
WordScorePoS
school0.0931221694711702NN
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school year equivalent per HAZ

Label: 4, with a score of: 0.809308086715638
WordScorePoS
school0.208127520578185NN
equivalent0JJ

Label: 5, with a score of: 0.362107445455348
WordScorePoS
school0.0931221694711702NN
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school year equivalent per HAZ

Label: 4, with a score of: 0.809308086715638
WordScorePoS
school0.208127520578185NN
equivalent0JJ

Label: 5, with a score of: 0.362107445455348
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grade per year faster school progression women higher school dropout rate by age Daniels and Adair Philippines Cebu Longitudinal HAZ < HAZ to HAZ to grade repetition grade repetition grade repetitionb

Label: 4, with a score of: 0.684581878720663
WordScorePoS
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WordScorePoS
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year delayed school enrollment per unit decrease in HAZ increase in girls enrollment increase in boys enrollment months delayed enrollment per unit HAZ decline

Label: 5, with a score of: 0.758860094685906
WordScorePoS
school0.0931221694711702NN
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year delayed enrollment per unit HAZ decline Primary school enrollment Glewwe and Jacoby Ghana Cross sectional HAZ Alderman and others Pakistan rural Longitudinal

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WordScorePoS
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HAZ increase Glewwe Jacoby and King Alderman and others Effect of diarrhea Lorntz and others Philippines Cebu Longitudinal Longitudinal HAZ HAZ Longitudinal Number of diarrheal episodes years Uganda rural Brazil shantytown

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WordScorePoS
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month delayed school enrollment per episode of diarrhea Source Compiled by World Bank team

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WordScorePoS
school0.208127520578185NN
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Estimated here from table in Grantham McGregor and others

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Repetition rates are relative to less than standard deviation estimated here from odds ratios and data presented in Daniels and Adair

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL estimate that mild stunting HAZ to is associated with loss of

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WordScorePoS
environmental0JJ
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environmental0JJ
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Label: 12, with a score of: 0.313498847847564
WordScorePoS
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years of schooling

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WordScorePoS
schooling0.0407408489778079NN

Alderman and others using longitudinal data relating to children in rural Zimbabwe find that decline in HAZ of is associated with loss of

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WordScorePoS
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datum0NN
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loss0NN

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years of grade attainment and

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years of delayed primary school enrollment

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WordScorePoS
primary0.108423939529757JJ
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Grade attainment is defined as completed grades in primary and secondary school

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Behrman and others using longitudinal data of children followed into adulthood in rural Guatemala assess the effect of preschool schooling and postschooling experiences on adult cognitive skills reading comprehension and nonverbal skills

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They find that preschool nonstunting HAZ ≥ increases reading comprehension test scores by the same amount as

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additional years of schooling attainment

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Using sample and subsample mean values of HAZ reported in the study an improvement in HAZ of has an effect on reading comprehension equivalent to nearly one additional year of schooling attainment

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Stunting is also found to have profound negative effect on nonverbal test scores

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stunt0.11668334276823NN
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To the extent that nonverbal cognitive skills may affect learning productivity per year of schooling this estimated effect of change in HAZ of on schooling attainment is conservative

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Maluccio Hoddinott and Behrman use the same data set to evaluate the effect of early childhood nutrition supplementation in Guatemala

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datum0NN
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The supplement was found to decrease the prevalence of severe stunting by percent increase the height of three year old children by

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decrease0NN
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centimeters and increase school grade attainment by one full year for women

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increase0.00402768349408688NN
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full0.0465610847355851JJ
woman0.221979360474357NN

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No significant effect on schooling was found for men

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significant0.0127591822694525JJ
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The effect for women comes through reduction in women who never attended school and an increase in women who progressed into secondary school

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effect0NN
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Women who received supplementation progressed faster through school than women who did not receive supplementation at rate of

Label: 5, with a score of: 0.696182284436329
WordScorePoS
woman0.221979360474357NN
receive0VB
progress0.0335134328085675NN
faster0RBR
school0.0931221694711702NN
rate0NN

Label: 4, with a score of: 0.465951081484176
WordScorePoS
woman0.0610612445035112NN
receive0VB
progress0.0299609328954485NN
faster0RBR
school0.208127520578185NN
rate0.0216847879059514NN

Label: 3, with a score of: 0.399643776546205
WordScorePoS
woman0.0381514605760894NN
receive0.0814816979556159VB
progress0.0449274832628543NN
faster0RBR
school0NN
rate0.0433561464459019NN

grade per year in school

Label: 4, with a score of: 0.880363915968639
WordScorePoS
school0.208127520578185NN

Label: 5, with a score of: 0.393899843477631
WordScorePoS
school0.0931221694711702NN

Walker and others using longitudinal data of children in Kingston Jamaica find that to year olds stunted by the age of two HAZ < had school dropout rate twice as high as children who were not stunted HAZ >

Label: 4, with a score of: 0.507607891250072
WordScorePoS
datum0NN
child0.076326555629389NN
stunt0NN
age0.0255262687343935NN
school0.208127520578185NN
rate0.0216847879059514NN

Label: 2, with a score of: 0.528138749289777
WordScorePoS
datum0NN
child0.0546336178945768NN
stunt0.11668334276823NN
age0.0365427838531249NN
school0.0297950283197006NN
rate0.0155217067874935NN

Label: 3, with a score of: 0.430876559504701
WordScorePoS
datum0NN
child0.10682408961305NN
stunt0NN
age0.0893142758861673NN
school0NN
rate0.0433561464459019NN

Label: 1, with a score of: 0.332298179731341
WordScorePoS
datum0NN
child0.0450489732120807NN
stunt0NN
age0.112994637345193NN
school0NN
rate0.0639932865717261NN

Daniels and Adair use longitudinal data of children in the Cebu metropolitan area urban and rural households in the Philippines

Label: 11, with a score of: 0.709319200396761
WordScorePoS
datum0NN
child0.0273960270556257NN
urban0.27622591898666JJ
rural0.0373517915079663JJ
household0NN

Label: 2, with a score of: 0.485544104746593
WordScorePoS
datum0NN
child0.0546336178945768NN
urban0JJ
rural0.148975141598503JJ
household0.0297950283197006NN

They estimate odds ratios for completing high school delayed enrollment and grade repetition in relation to early childhood stunting

Label: 4, with a score of: 0.832455932446686
WordScorePoS
estimate0.0299609328954485NN
ratio0NN
complete0.0815069365350084JJ
school0.208127520578185NN
relation0NN
childhood0.0815069365350084NN
stunt0NN

Label: 5, with a score of: 0.336193944607097
WordScorePoS
estimate0NN
ratio0.0688661930304451NN
complete0JJ
school0.0931221694711702NN
relation0NN
childhood0NN
stunt0NN

Label: 2, with a score of: 0.304004192740589
WordScorePoS
estimate0NN
ratio0NN
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school0.0297950283197006NN
relation0NN
childhood0NN
stunt0.11668334276823NN

Using the odds ratios and data presented in their article one can infer that severe stunting in early childhood HAZ < is associated with

Label: 2, with a score of: 0.612247210306518
WordScorePoS
ratio0NN
datum0NN
stunt0.11668334276823NN
childhood0NN

years of lower grade attainment that moderate stunting HAZ to is associated with

Label: 2, with a score of: 1
WordScorePoS
stunt0.11668334276823NN

years of lower attainment and that mild stunting HAZ to is associated with

Label: 2, with a score of: 1
WordScorePoS
stunt0.11668334276823NN

years of lower attainment

Label: 0, with a score of: 1

Daniels and Adair also find that severe stunting is associated with repeating grade REVIEW OF STUDIES ON NUTRITIONAL STATUS AND EDUCATION at least once percent of severely stunted children and that percent of mildly stunted children repeat grade at least once as result of stunting

Label: 4, with a score of: 0.468429297410842
WordScorePoS
stunt0NN
review0NN
study0NN
nutritional0JJ
status0NN
education0.244244978014045NN
severely0RB
child0.076326555629389NN
result0NN

Glewwe Jacoby and King using longitudinal data relating to more than children in the Cebu metropolitan area investigate the effect of stunting on learning productivity per year of schooling through primary school using achievement test scores sum of math and English

Label: 4, with a score of: 0.76650515529332
WordScorePoS
datum0NN
child0.076326555629389NN
effect0NN
stunt0NN
learn0.244520809605025VB
productivity0NN
schooling0NN
primary0.108423939529757JJ
school0.208127520578185NN
achievement0NN

Label: 2, with a score of: 0.385167869506449
WordScorePoS
datum0NN
child0.0546336178945768NN
effect0.0440683498519077NN
stunt0.11668334276823NN
learn0VB
productivity0.0595900566394012NN
schooling0NN
primary0.0155217067874935JJ
school0.0297950283197006NN
achievement0NN

They then convert the effect of stunting on test scores into the extra months of schooling it takes to compensate for the difference in test scores

Label: 2, with a score of: 0.934842491948964
WordScorePoS
effect0.0440683498519077NN
stunt0.11668334276823NN
schooling0NN

They find that the effect on test scores of change in HAZ of is equivalent to

Label: 13, with a score of: 0.879956427523715
WordScorePoS
effect0NN
change0.402565546215053NN
equivalent0JJ

Label: 2, with a score of: 0.339657008869518
WordScorePoS
effect0.0440683498519077NN
change0.0756001353333673NN
equivalent0.0357189919948307JJ

year of school attendance and for the more severely stunted children HAZ <

Label: 4, with a score of: 0.701823274074726
WordScorePoS
school0.208127520578185NN
severely0RB
stunt0NN
child0.076326555629389NN

Label: 2, with a score of: 0.496196350726174
WordScorePoS
school0.0297950283197006NN
severely0RB
stunt0.11668334276823NN
child0.0546336178945768NN

it is equivalent to

Label: 12, with a score of: 0.73736624946011
WordScorePoS
equivalent0.0664302389559493JJ

Label: 8, with a score of: 0.546898518605942
WordScorePoS
equivalent0.049270765107907JJ

Label: 2, with a score of: 0.396475755253403
WordScorePoS
equivalent0.0357189919948307JJ

years of schooling

Label: 3, with a score of: 1
WordScorePoS
schooling0.0407408489778079NN

Glewwe Jacoby and King also find that decline in HAZ of delays primary school enrollment by two months and increases the probability of first grade repetition by percent

Label: 4, with a score of: 0.804758818131643
WordScorePoS
decline0NN
primary0.108423939529757JJ
school0.208127520578185NN
increase0.0144029596227568NN

Label: 5, with a score of: 0.472158808797306
WordScorePoS
decline0NN
primary0.0970239057629001JJ
school0.0931221694711702NN
increase0.00402768349408688NN

Using the baseline data in Daniels and Adair on frequency of grade repetition by stunting status they find that grade repetition of percent is equivalent to

Label: 2, with a score of: 0.70433994862974
WordScorePoS
datum0NN
stunt0.11668334276823NN
status0NN
equivalent0.0357189919948307JJ

month delay in labor force entry for severely stunted child and

Label: 2, with a score of: 0.703466688798353
WordScorePoS
force0.0297950283197006NN
severely0RB
stunt0.11668334276823NN
child0.0546336178945768NN

Label: 3, with a score of: 0.44643650152939
WordScorePoS
force0.020806307400253NN
severely0RB
stunt0NN
child0.10682408961305NN

Label: 8, with a score of: 0.301924202407914
WordScorePoS
force0.0410992516792148NN
severely0RB
stunt0NN
child0.0452169560888236NN

month delay for mildly stunted child

Label: 2, with a score of: 0.720144840066716
WordScorePoS
stunt0.11668334276823NN
child0.0546336178945768NN

Label: 3, with a score of: 0.449043787795637
WordScorePoS
stunt0NN
child0.10682408961305NN

Label: 4, with a score of: 0.320844912166966
WordScorePoS
stunt0NN
child0.076326555629389NN

Alderman and others using longitudinal data on more than children in rural Pakistan find that

Label: 2, with a score of: 0.70645841907901
WordScorePoS
datum0NN
child0.0546336178945768NN
rural0.148975141598503JJ

Label: 3, with a score of: 0.370646025522075
WordScorePoS
datum0NN
child0.10682408961305NN
rural0JJ

increase in HAZ is associated with an percent increase in girls school enrollment and percent increase in boys school enrollment

Label: 5, with a score of: 0.699807577026113
WordScorePoS
increase0.00402768349408688NN
girl0.393804437159645NN
school0.0931221694711702NN
boy0.206598579091335NN

Label: 4, with a score of: 0.687766022005817
WordScorePoS
increase0.0144029596227568NN
girl0.140824109342254NN
school0.208127520578185NN
boy0.184698660975968NN

Glewwe and Jacoby find in study of children in Ghana albeit using cross sectional data that decline in HAZ of is associated with

Label: 3, with a score of: 0.604641341181322
WordScorePoS
study0NN
child0.10682408961305NN
datum0NN
decline0.0351951258079907NN

month delay in primary school enrollment

Label: 4, with a score of: 0.82796501139059
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN

Label: 5, with a score of: 0.497341877031206
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN

Diarrhea and Education Lorntz and others using longitudinal data on children in shantytown in northern Brazil estimate the effect of early childhood diarrheal episodes on subsequent timing of primary school enrollment

Label: 4, with a score of: 0.83301561245867
WordScorePoS
education0.244244978014045NN
datum0NN
child0.076326555629389NN
northern0JJ
estimate0.0299609328954485NN
effect0NN
childhood0.0815069365350084NN
primary0.108423939529757JJ
school0.208127520578185NN

Label: 5, with a score of: 0.36422745810543
WordScorePoS
education0.0512260062633133NN
datum0NN
child0.0170753354211044NN
northern0.0688661930304451JJ
estimate0NN
effect0NN
childhood0NN
primary0.0970239057629001JJ
school0.0931221694711702NN

month delay in enrollment per diarrheal episode in the first two years of life

Label: 0, with a score of: 1

The median number of episodes in the first two years of life was

Label: 0, with a score of: 1

On average this finding corresponds to two week prevalence rate of nearly percent which is the same as reported in the Ghana Demographic and Health Survey for children under two years of age

Label: 3, with a score of: 0.717436945448288
WordScorePoS
average0NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
report0.0307735781890304NN
health0.191387734041787NN
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child0.10682408961305NN
age0.0893142758861673NN

Label: 10, with a score of: 0.447744664411878
WordScorePoS
average0.146608885563018NN
prevalence0NN
rate0.0172128079963482NN
report0NN
health0.0405241466500776NN
survey0.064698038783335NN
child0.0242343960710022NN
age0.0202620733250388NN

Label: 13, with a score of: 0.236543013760308
WordScorePoS
average0.1656430212089NN
prevalence0NN
rate0NN
report0NN
health0NN
survey0NN
child0NN
age0NN

Label: 1, with a score of: 0.3170750957666
WordScorePoS
average0NN
prevalence0NN
rate0.0639932865717261NN
report0NN
health0NN
survey0NN
child0.0450489732120807NN
age0.112994637345193NN

Reducing this prevalence rate by half that is to percent would suggest reduction in delayed enrollment by about three months

Label: 3, with a score of: 0.52140282539108
WordScorePoS
reduce0.01675146888405VB
prevalence0.0407408489778079NN
rate0.0433561464459019NN
suggest0VB
reduction0.0149758277542848NN

Label: 10, with a score of: 0.431317826109875
WordScorePoS
reduce0.0310356414389692VB
prevalence0NN
rate0.0172128079963482NN
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reduction0.0475643836183697NN

Conclusions The literature reviewed and presented in table B

Label: 17, with a score of: 0.780201501737792
WordScorePoS
conclusion0.048933054487825NN
review0.036961556179878NN

Label: 5, with a score of: 0.625528270093442
WordScorePoS
conclusion0NN
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provides substantial evidence of significant effect of malnutrition on children educational performance

Label: 10, with a score of: 0.572771813762626
WordScorePoS
substantial0JJ
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effect0NN
malnutrition0NN
child0.0242343960710022NN
educational0JJ
performance0.064698038783335NN

Label: 1, with a score of: 0.508877732457807
WordScorePoS
substantial0.0736315832425121JJ
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malnutrition0.0736315832425121NN
child0.0450489732120807NN
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performance0NN

Label: 6, with a score of: 0.300410325279032
WordScorePoS
substantial0JJ
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effect0NN
malnutrition0.041835863322702NN
child0.0255958462813622NN
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performance0NN

The single most important effect is reduced learning productivity during schooling followed by reduced grade attainment

Label: 4, with a score of: 0.666649578188264
WordScorePoS
single0JJ
effect0NN
reduce0VB
learn0.244520809605025VB
productivity0NN
schooling0NN

Label: 2, with a score of: 0.485269664948527
WordScorePoS
single0.0583416713841148JJ
effect0.0440683498519077NN
reduce0.00799614078871077VB
learn0VB
productivity0.0595900566394012NN
schooling0NN

Label: 9, with a score of: 0.375448847077596
WordScorePoS
single0JJ
effect0.0454743001434393NN
reduce0VB
learn0VB
productivity0.0922368138456871NN
schooling0NN

Delayed primary school enrollment and ENVIRONMENTAL HEALTH AND CHILD SURVIVAL grade repetition while important in their own rights have much lesser consequence for lifetime income see appendix and chapter

Label: 4, with a score of: 0.541334892218348
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
environmental0JJ
health0NN
child0.076326555629389NN
rights0.0352060273355634NNS
income0NN

Label: 3, with a score of: 0.413064191042697
WordScorePoS
primary0.0108390366114755JJ
school0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
rights0.0175975629039954NNS
income0NN

Label: 10, with a score of: 0.322481304538032
WordScorePoS
primary0JJ
school0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
child0.0242343960710022NN
rights0NNS
income0.166475342664294NN

Label: 5, with a score of: 0.433853144388239
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN
environmental0JJ
health0.0571058915334038NN
child0.0170753354211044NN
rights0.078760887431929NNS
income0NN

The effects of malnutrition on educational performance as applied to Ghana and Pakistan to estimate the impact on lifetime income are presented in table

Label: 10, with a score of: 0.563115895858348
WordScorePoS
effect0NN
malnutrition0NN
educational0JJ
performance0.064698038783335NN
estimate0NN
impact0NN
income0.166475342664294NN

Label: 9, with a score of: 0.473223890517077
WordScorePoS
effect0.0454743001434393NN
malnutrition0NN
educational0JJ
performance0NN
estimate0.0221298700466866NN
impact0.0160169090870187NN
income0.110649350233433NN

Label: 2, with a score of: 0.351072921019231
WordScorePoS
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
educational0JJ
performance0NN
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impact0NN
income0.0643370113878709NN

Label: 6, with a score of: 0.312644067327416
WordScorePoS
effect0NN
malnutrition0.041835863322702NN
educational0.0683326727248364JJ
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impact0.0181797964452808NN
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see also table D

Label: 0, with a score of: 1

in appendix

Label: 0, with a score of: 1

The attributable fraction of malnutrition stunting from diarrheal infections associated with water sanitation and hygiene is discussed in appendixes and D

Label: 6, with a score of: 0.953670718229152
WordScorePoS
malnutrition0.041835863322702NN
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infection0NN
water0.556409482163189NN
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hygiene0.136665345449673NN

Label: 12, with a score of: 0.166639890879681
WordScorePoS
malnutrition0NN
stunt0NN
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water0.186896403054502NN
sanitation0NN
hygiene0NN

The relation between educational performance and future income is discussed in chapter

Label: 10, with a score of: 0.844549871989155
WordScorePoS
relation0.064698038783335NN
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performance0.064698038783335NN
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income0.166475342664294NN

Label: 9, with a score of: 0.315842924275622
WordScorePoS
relation0NN
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income0.110649350233433NN

Note This appendix is based on review of several recent longitudinal studies that looked at the effect of low height for age in childhood on educational outcomes

Label: 1, with a score of: 0.699100778527668
WordScorePoS
base0.0442083771593746NN
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Label: 4, with a score of: 0.374554692862916
WordScorePoS
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This review was carried out by Bjørn Larsen consultant specifically for this report

Label: 0, with a score of: 1

P E D X New Estimates for Burden of Disease from Water Sanitation and Hygiene THE ESTIMATES IN TABLE C

Label: 6, with a score of: 0.914128177897339
WordScorePoS
estimate0NN
burden0NN
disease0.103230094596636NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN

Label: 3, with a score of: 0.322042421412865
WordScorePoS
estimate0.059903311017139NN
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disease0.215415047323213NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN

Label: 12, with a score of: 0.18329662904383
WordScorePoS
estimate0.0199423462679015NN
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water0.186896403054502NN
sanitation0NN
hygiene0NN

ARE FROM the new study by the World Health Organization Fewtrell and others

Label: 3, with a score of: 0.820087219243333
WordScorePoS
study0NN
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN

The study incorporates the effects through malnutrition of water sanitation and hygiene on mortality and disease burden

Label: 6, with a score of: 0.880035589227809
WordScorePoS
study0NN
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malnutrition0.041835863322702NN
water0.556409482163189NN
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mortality0NN
disease0.103230094596636NN
burden0NN

Label: 3, with a score of: 0.416894932988548
WordScorePoS
study0NN
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water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
mortality0.276962203701274NN
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burden0NN

Label: 12, with a score of: 0.140238406112486
WordScorePoS
study0NN
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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE C

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN

Burden of Disease in DALYs in Children under Five Years Attributable to Water Sanitation and Hygiene by World Health Organization Subregions Mortality stratum thousands Africa DALYs Attributable to WSHDeveloped Developing Number Related Risk Countries Countries thousands thousands thousands High Child High Adult Americas High Child Very Low Very Child High Very Low Adult Adult Low Child Low Adult High Child High Adult Population of children under years Total DALYs Total WSHrelated DALYs Percentage of total DALYs Diarrheal diseasesa Intestinal nematode infectionsb Malnutrition only proteinenergy malnutrition Consequences of malnutritiona Trachomab Schistosomiasisb Lymphatic filariasis

Label: 3, with a score of: 0.545177846023732
WordScorePoS
burden0NN
disease0.215415047323213NN
child0.10682408961305NN
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world0.00087176582269799NN
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africa0IN
develop0VB
related0.0125195145191824JJ
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adult0JJ
population0NN
total0NN
percentage0NN
malnutrition0NN

Label: 6, with a score of: 0.538172360482589
WordScorePoS
burden0NN
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child0.0255958462813622NN
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adult0JJ
population0.0363595928905615NN
total0.0295155485671997NN
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malnutrition0.041835863322702NN

Label: 4, with a score of: 0.461483634417404
WordScorePoS
burden0NN
disease0NN
child0.076326555629389NN
water0NN
sanitation0NN
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world0.0017440716962658NN
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adult0.163013873070017JJ
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total0NN
percentage0NN
malnutrition0NN

Label: 12, with a score of: 0.132830461450992
WordScorePoS
burden0NN
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child0NN
water0.186896403054502NN
sanitation0NN
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world0.00464349782489754NN
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organization0NN
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africa0IN
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population0.0144336476662975NN
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malnutrition0NN

Subtotal WSH

Label: 0, with a score of: 1

Malaria

Label: 3, with a score of: 1
WordScorePoS
malaria0.20370424488904NN

Dengue

Label: 0, with a score of: 1

Japanese encephalitis

Label: 0, with a score of: 1

Onchocerciasis Subtotal water resources management

Label: 6, with a score of: 0.85346985543744
WordScorePoS
water0.556409482163189NN
resource0.0104991907358033NN
management0.0428007293971684NN

Label: 12, with a score of: 0.367525506632042
WordScorePoS
water0.186896403054502NN
resource0.0416785799329393NN
management0.0339811641917276NN

Drownings

Label: 0, with a score of: 1

Subtotal safety of water environments

Label: 6, with a score of: 0.865545632731637
WordScorePoS
safety0NN
water0.556409482163189NN
environment0NN

Label: 12, with a score of: 0.414822923962676
WordScorePoS
safety0NN
water0.186896403054502NN
environment0.079769385071606NN

Other infectious diseasesc

Label: 0, with a score of: 1

Source Data based on literature review expert survey

Label: 17, with a score of: 0.618679354093749
WordScorePoS
source0.0109843026967392NN
datum0.0739231123597559NN
base0.017987180284335NN
review0.036961556179878NN
survey0NN

Label: 14, with a score of: 0.365168925019272
WordScorePoS
source0.0238835024181023NN
datum0NN
base0.058665107245718NN
review0NN
survey0NN

Label: 1, with a score of: 0.314989633736722
WordScorePoS
source0.0269969049497485NN
datum0NN
base0.0442083771593746NN
review0NN
survey0NN

Not formal WHO estimate but based on Prüss Üstün and Corvalán

Label: 14, with a score of: 0.576209498202695
WordScorePoS
estimate0.0195550357485727NN
base0.058665107245718NN

Label: 3, with a score of: 0.55159795579102
WordScorePoS
estimate0.059903311017139NN
base0.0149758277542848NN

Notes DALY disability affected life year WSH water sanitation and hygiene

Label: 6, with a score of: 0.94983016744123
WordScorePoS
disability0NN
affect0.0209983814716066VB
life0NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN

Label: 12, with a score of: 0.207013416243379
WordScorePoS
disability0NN
affect0.0166714319731757VB
life0.0250071479597636NN
water0.186896403054502NN
sanitation0NN
hygiene0NN

Subtotals may not add because of rounding

Label: 2, with a score of: 0.823195605942787
WordScorePoS
add0VB
round0.11668334276823NN

Label: 8, with a score of: 0.567757865957388
WordScorePoS
add0.0804764811724088VB
round0NN

Data further validated by Comparative Risk Assessment methods

Label: 17, with a score of: 0.518680919289422
WordScorePoS
datum0.0739231123597559NN
risk0NN

Label: 3, with a score of: 0.49389263048761
WordScorePoS
datum0NN
risk0.0703902516159815NN

Label: 11, with a score of: 0.443321686217852
WordScorePoS
datum0NN
risk0.0631828116343571NN

Included in the Comparative Risk Assessment study

Label: 15, with a score of: 0.55574763963764
WordScorePoS
include0VB
risk0.0223459295604043NN
study0.0517339898971162NN

Label: 3, with a score of: 0.528067747313269
WordScorePoS
include0VB
risk0.0703902516159815NN
study0NN

Label: 11, with a score of: 0.47399752441144
WordScorePoS
include0VB
risk0.0631828116343571NN
study0NN

Label: 1, with a score of: 0.389711649365208
WordScorePoS
include0VB
risk0.0519476926891779NN
study0NN

Not attributable to one group alone

Label: 0, with a score of: 1

Percentage of all DALYs attributable to WSH related risks

Label: 2, with a score of: 0.533051711329687
WordScorePoS
percentage0.0583416713841148NN
related0.00896409157262106JJ
risk0.0252000451111224NN

Label: 3, with a score of: 0.477755869035527
WordScorePoS
percentage0NN
related0.0125195145191824JJ
risk0.0703902516159815NN

Label: 11, with a score of: 0.428837209521024
WordScorePoS
percentage0NN
related0.0112376090361851JJ
risk0.0631828116343571NN

Label: 1, with a score of: 0.405822139314172
WordScorePoS
percentage0NN
related0.0184786920895884JJ
risk0.0519476926891779NN

NEW ESTIMATES FOR BURDEN OF DISEASE FROM WATER SANITATION AND HYGIENE Mortality stratum thousands Eastern Mediterranean Low Child Low Adult Europe Southeast Asia High Child High Adult Very Low Child Very Low Adult Low Child Low Adult Low Child High Adult Low Child Low Adult

Label: 4, with a score of: 0.595686615406426
WordScorePoS
estimate0.0299609328954485NN
burden0NN
disease0NN
water0NN
sanitation0NN
hygiene0NN
mortality0NN
eastern0JJ
child0.076326555629389NN
adult0.163013873070017JJ
asia0IN

Label: 3, with a score of: 0.527090616820387
WordScorePoS
estimate0.059903311017139NN
burden0NN
disease0.215415047323213NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
mortality0.276962203701274NN
eastern0.0407408489778079JJ
child0.10682408961305NN
adult0JJ
asia0IN

Label: 6, with a score of: 0.521962812589448
WordScorePoS
estimate0NN
burden0NN
disease0.103230094596636NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
mortality0NN
eastern0JJ
child0.0255958462813622NN
adult0JJ
asia0IN

Label: 12, with a score of: 0.0840455524770646
WordScorePoS
estimate0.0199423462679015NN
burden0NN
disease0NN
water0.186896403054502NN
sanitation0NN
hygiene0NN
mortality0NN
eastern0JJ
child0NN
adult0JJ
asia0IN

Western Pacific High Child High Adult Very low Child Very Low Adult Low Child Low Adult P E X Computing Country Level Environmental Health Burden of Disease THIS APPENDIX PROVIDES DESCRIPTION OF THE METHODS used to estimate the environmental health burden of disease including effects on education and relative monetary costs

Label: 3, with a score of: 0.665079487723784
WordScorePoS
western0JJ
child0.10682408961305NN
adult0JJ
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
estimate0.059903311017139NN
include0VB
effect0NN
education0.0152605842304358NN
relative0JJ
cost0NN

Label: 4, with a score of: 0.558455956486703
WordScorePoS
western0JJ
child0.076326555629389NN
adult0.163013873070017JJ
country0NN
level0.0231525547935232NN
environmental0JJ
health0NN
burden0NN
disease0NN
estimate0.0299609328954485NN
include0VB
effect0NN
education0.244244978014045NN
relative0JJ
cost0NN

An overview of the results for Ghana and Pakistan has been provided in chapter

Label: 6, with a score of: 1
WordScorePoS
result0.0683326727248364NN

The methodology summarized graphically in figure D

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

has two main components

Label: 0, with a score of: 1

The first involves the valuation of mortality for each cause of death left side of figure D

Label: 3, with a score of: 0.948771874492955
WordScorePoS
involve0VB
mortality0.276962203701274NN
death0.193573191943949NN
figure0NN

and the second relates to the estimation of educational costs of disease right side of figure D

Label: 3, with a score of: 0.724544739562757
WordScorePoS
educational0JJ
cost0NN
disease0.215415047323213NN
figure0NN

Label: 6, with a score of: 0.577048363669285
WordScorePoS
educational0.0683326727248364JJ
cost0NN
disease0.103230094596636NN
figure0NN

Mortality This section details the steps used to estimate mortality from environmental health risks figure D

Label: 3, with a score of: 0.94222338875991
WordScorePoS
mortality0.276962203701274NN
estimate0.059903311017139NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
figure0NN

steps to

Label: 0, with a score of: 1

The environmentally attributable disease in Ghana is estimated in reference to diarrhea acute lower respiratory infections ALRI malaria measles protein energy malnutrition and residual group of other causes of mortality table D

Label: 3, with a score of: 0.848493766577826
WordScorePoS
environmentally0RB
disease0.215415047323213NN
estimate0.059903311017139NN
infection0.122222546933424NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
protein0NN
energy0NN
malnutrition0NN
mortality0.276962203701274NN

Label: 7, with a score of: 0.456695577631544
WordScorePoS
environmentally0RB
disease0NN
estimate0NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN
malnutrition0NN
mortality0NN

Label: 12, with a score of: 0.142103787344405
WordScorePoS
environmentally0RB
disease0NN
estimate0.0199423462679015NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN
malnutrition0NN
mortality0NN

It is important to note that diarrhea constitutes both cause of death and risk factor through its effect on malnutrition and consequent mortality

Label: 3, with a score of: 0.918932358894747
WordScorePoS
death0.193573191943949NN
risk0.0703902516159815NN
effect0NN
malnutrition0NN
mortality0.276962203701274NN

Deaths related to urban air pollution are not included because of the small effects on child mortality that can be calculated from current estimation methods

Label: 3, with a score of: 0.753620954907919
WordScorePoS
death0.193573191943949NN
related0.0125195145191824JJ
urban0JJ
air0.020806307400253NN
pollution0.0175975629039954NN
include0VB
effect0NN
child0.10682408961305NN
mortality0.276962203701274NN
current0JJ

Label: 11, with a score of: 0.498262418233392
WordScorePoS
death0.0315914058171786NN
related0.0112376090361851JJ
urban0.27622591898666JJ
air0.0373517915079663NN
pollution0.0315914058171786NN
include0VB
effect0NN
child0.0273960270556257NN
mortality0NN
current0JJ

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL FIGURE D

Label: 3, with a score of: 0.738034958017592
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
figure0NN

Summary of the Methodology Mortality Education Step Data collection Step Creation of exposure categories assessment of population at risk Step Assessment of relative risk in each exposure category Step Assessment of counterfactual population at risk if no diarrheal infections and no other environmental health risk exposure Step Estimation of mortality attributable to environmental health risks direct indirect effect Step Data collection on current child population prevalence of malnutrition stunting Step Assessment of counterfactual child population prevalence of malnutrition stunting Step Assessment of attributable loss in school performance from malnutrition Step Valuation Estimation of current and counterfactual lifetime income of children Calculation of difference between current and counterfactual lifetime income for the whole population Step Valuation Source Compiled by World Bank team

Label: 3, with a score of: 0.57705104913916
WordScorePoS
mortality0.276962203701274NN
education0.0152605842304358NN
datum0NN
collection0NN
creation0NN
exposure0NN
population0NN
risk0.0703902516159815NN
relative0JJ
infection0.122222546933424NN
environmental0JJ
health0.191387734041787NN
direct0JJ
effect0NN
current0JJ
child0.10682408961305NN
prevalence0.0407408489778079NN
malnutrition0NN
stunt0NN
loss0NN
school0NN
performance0NN
income0NN
source0NN
world0.00087176582269799NN
bank0NN

Label: 10, with a score of: 0.372778916379449
WordScorePoS
mortality0.0488696285210061NN
education0.0121171980355011NN
datum0NN
collection0NN
creation0NN
exposure0NN
population0.0860640399817412NN
risk0NN
relative0JJ
infection0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
direct0.0396106020715138JJ
effect0NN
current0JJ
child0.0242343960710022NN
prevalence0NN
malnutrition0NN
stunt0NN
loss0NN
school0NN
performance0.064698038783335NN
income0.166475342664294NN
source0NN
world0.00276879546803864NN
bank0NN

Label: 4, with a score of: 0.215522155157855
WordScorePoS
mortality0NN
education0.244244978014045NN
datum0NN
collection0NN
creation0NN
exposure0NN
population0NN
risk0NN
relative0JJ
infection0NN
environmental0JJ
health0NN
direct0JJ
effect0NN
current0JJ
child0.076326555629389NN
prevalence0NN
malnutrition0NN
stunt0NN
loss0NN
school0.208127520578185NN
performance0NN
income0NN
source0NN
world0.0017440716962658NN
bank0NN

Label: 8, with a score of: 0.185098564758271
WordScorePoS
mortality0NN
education0.0150723186962745NN
datum0NN
collection0NN
creation0.160952962344818NN
exposure0NN
population0.0428212738652355NN
risk0NN
relative0JJ
infection0NN
environmental0.0295821503613099JJ
health0NN
direct0JJ
effect0NN
current0JJ
child0.0452169560888236NN
prevalence0NN
malnutrition0NN
stunt0NN
loss0NN
school0NN
performance0NN
income0NN
source0NN
world0.00172202218602071NN
bank0NN

TABLE D

Label: 0, with a score of: 1

Causes of Death and Risk Factors Considered in this Study Cause of Death Direct Environmental Risk Factor Indirect Risk Factor Diarrhea Inadequate water sanitation and hygiene Indoor air pollution Malnutrition through diarrheal infections Malnutrition through diarrheal infections Malnutrition through diarrheal infections Malnutrition through diarrheal infections Malnutrition through diarrheal infections Malnutrition through diarrheal infections Acute lower respiratory infection Malaria Measles Protein energy malnutrition Other causes of mortality excluding perinatal conditions Poor management of water resources Nonea Nonea Nonea Source Compiled by World Bank team

Label: 6, with a score of: 0.632064951293453
WordScorePoS
death0.0295155485671997NN
risk0NN
study0NN
direct0JJ
environmental0JJ
inadequate0.0836717266454039JJ
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
air0NN
pollution0.0590310971343993NN
malnutrition0.041835863322702NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.0153390539205676NN
mortality0NN
condition0NN
poor0.0642010940957526JJ
management0.0428007293971684NN
resource0.0104991907358033NN
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 3, with a score of: 0.590842881405349
WordScorePoS
death0.193573191943949NN
risk0.0703902516159815NN
study0NN
direct0JJ
environmental0JJ
inadequate0JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
air0.020806307400253NN
pollution0.0175975629039954NN
malnutrition0NN
infection0.122222546933424NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
protein0NN
energy0NN
mortality0.276962203701274NN
condition0NN
poor0JJ
management0.0127591822694525NN
resource0NN
source0NN
world0.00087176582269799NN
bank0NN

Label: 1, with a score of: 0.289548888293428
WordScorePoS
death0NN
risk0.0519476926891779NN
study0NN
direct0JJ
environmental0.0442083771593746JJ
inadequate0.0736315832425121JJ
water0NN
sanitation0NN
hygiene0NN
air0NN
pollution0NN
malnutrition0.0736315832425121NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0NN
mortality0NN
condition0NN
poor0.150659516460257JJ
management0NN
resource0.0739147683583536NN
source0.0269969049497485NN
world0.00257343720272548NN
bank0NN

Label: 12, with a score of: 0.222505596442046
WordScorePoS
death0NN
risk0NN
study0NN
direct0JJ
environmental0.0598270388037045JJ
inadequate0JJ
water0.186896403054502NN
sanitation0NN
hygiene0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
malnutrition0NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN
mortality0NN
condition0.0409791940864438NN
poor0.0339811641917276JJ
management0.0339811641917276NN
resource0.0416785799329393NN
source0NN
world0.00464349782489754NN
bank0NN

Label: 7, with a score of: 0.145632305765705
WordScorePoS
death0NN
risk0NN
study0NN
direct0JJ
environmental0JJ
inadequate0JJ
water0NN
sanitation0NN
hygiene0NN
air0NN
pollution0NN
malnutrition0NN
infection0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN
mortality0NN
condition0NN
poor0JJ
management0NN
resource0NN
source0.0274787313211514NN
world0.00261936653839306NN
bank0NN

This report focuses on water sanitation and hygiene indoor air pollution and water resource management

Label: 6, with a score of: 0.910503735033767
WordScorePoS
report0NN
focus0NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
air0NN
pollution0.0590310971343993NN
resource0.0104991907358033NN
management0.0428007293971684NN

Label: 12, with a score of: 0.305528546834547
WordScorePoS
report0.0409791940864438NN
focus0NN
water0.186896403054502NN
sanitation0NN
hygiene0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
resource0.0416785799329393NN
management0.0339811641917276NN

None of these environmental health risks are considered to contribute significantly to these causes of death

Label: 3, with a score of: 0.830906431567579
WordScorePoS
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
contribute0VB
significantly0RB
death0.193573191943949NN

Label: 11, with a score of: 0.312853840765686
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
contribute0VB
significantly0RB
death0.0315914058171786NN

COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE Total observed mortality denoted as in any given population is the result of exposure to different risk factors

Label: 3, with a score of: 0.828997699965847
WordScorePoS
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
total0NN
mortality0.276962203701274NN
population0NN
result0NN
exposure0NN
risk0.0703902516159815NN

If the fraction of mortality caused by environmental risk factors is denoted as FEH then mortality attributable to environmental health risks MEH is given by the formula EH ∑F EH Mj D

Label: 3, with a score of: 0.888088023773362
WordScorePoS
mortality0.276962203701274NN
cause0NN
environmental0JJ
risk0.0703902516159815NN
health0.191387734041787NN

where Mj is current annual cases of cause specific mortality is ALRI diarrhea EH malaria measles and other causes of deaths Fj is the fraction of cause specific deaths attributable to environmental health risks and MEH is the annual cases of mortality caused by environmental health risk factors

Label: 3, with a score of: 0.935486156531639
WordScorePoS
current0JJ
specific0JJ
mortality0.276962203701274NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
death0.193573191943949NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
cause0NN

The methodology for estimating MEH relies on the estimation of the impact EH fraction Fj for each cause of death j

Label: 3, with a score of: 0.754673084013748
WordScorePoS
estimate0.059903311017139NN
rely0VB
impact0NN
death0.193573191943949NN

Label: 12, with a score of: 0.41610413497121
WordScorePoS
estimate0.0199423462679015NN
rely0.0332151194779746VB
impact0.0866018859977851NN
death0NN

A general formula for the fraction of deaths attributable to set of risk factors is ∑ RR − ∑ RR ' ∑ RR D

Label: 3, with a score of: 0.847528706229487
WordScorePoS
death0.193573191943949NN
set0NN
risk0.0703902516159815NN

where the subscript denotes exposure category Pi is the population current exposure distribution P'i is the population counterfactual exposure distribution that is exposure distribution in the absence of environmental risks and RRi is the risk of mortality in each exposure category

Label: 3, with a score of: 0.440244314931492
WordScorePoS
exposure0NN
population0NN
current0JJ
environmental0JJ
risk0.0703902516159815NN
mortality0.276962203701274NN

Step Data Collection The estimation of the environmental health burden of disease and its subsequent monetary valuation uses data from variety of sources

Label: 3, with a score of: 0.69215388360614
WordScorePoS
datum0NN
collection0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
variety0NN
source0NN

Label: 17, with a score of: 0.416387159823463
WordScorePoS
datum0.0739231123597559NN
collection0.048933054487825NN
environmental0JJ
health0NN
burden0.036961556179878NN
disease0NN
variety0NN
source0.0109843026967392NN

Label: 1, with a score of: 0.325778924344728
WordScorePoS
datum0NN
collection0NN
environmental0.0442083771593746JJ
health0NN
burden0NN
disease0NN
variety0.120266261535276NN
source0.0269969049497485NN

Typical sources of information are listed in table D

Label: 9, with a score of: 0.599006893388166
WordScorePoS
source0.0135141354781442NN
information0.0675706773907211NN

Label: 6, with a score of: 0.453263624167568
WordScorePoS
source0.0613562156822703NN
information0NN

The more data are available from country sources the better

Label: 17, with a score of: 0.644232611126071
WordScorePoS
datum0.0739231123597559NN
country0NN
source0.0109843026967392NN

Label: 6, with a score of: 0.465538551744894
WordScorePoS
datum0NN
country0NN
source0.0613562156822703NN

Label: 9, with a score of: 0.447573087479453
WordScorePoS
datum0.0454743001434393NN
country0NN
source0.0135141354781442NN

As an alternative one can use information from international sources making the necessary assumptions to adapt the parameters to the country in question

Label: 9, with a score of: 0.750496219363161
WordScorePoS
alternative0.0602029956716497NN
information0.0675706773907211NN
international0.00265959362690358JJ
source0.0135141354781442NN
country0NN

Step Assessment of the Population at Risk To compute the health burden of each cause of death or disease from environmental risk factors one needs estimates of the population exposed to the relevant risk factors

Label: 3, with a score of: 0.810843557728233
WordScorePoS
population0NN
risk0.0703902516159815NN
health0.191387734041787NN
burden0NN
death0.193573191943949NN
disease0.215415047323213NN
environmental0JJ
estimate0.059903311017139NN
relevant0JJ

Label: 11, with a score of: 0.313313182363479
WordScorePoS
population0.0194583992186006NN
risk0.0631828116343571NN
health0.0229054731708393NN
burden0NN
death0.0315914058171786NN
disease0NN
environmental0.0537696560159885JJ
estimate0NN
relevant0JJ

Multiple environmental risk factors may contribute to particular disease and mortality from this disease and an environmental risk factor is often associated with several levels of risk

Label: 3, with a score of: 0.862327312632739
WordScorePoS
multiple0JJ
environmental0JJ
risk0.0703902516159815NN
contribute0VB
disease0.215415047323213NN
mortality0.276962203701274NN
level0NN

It is therefore desirable to create exposure categories allowing for as many combinations of risk factors and levels of risk as is practically ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE D

Label: 3, with a score of: 0.610678224727785
WordScorePoS
create0VB
exposure0NN
risk0.0703902516159815NN
level0NN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN

Label: 1, with a score of: 0.524099265640245
WordScorePoS
create0.0519476926891779VB
exposure0.120266261535276NN
risk0.0519476926891779NN
level0.0113874611101829NN
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN

Label: 11, with a score of: 0.374138542529732
WordScorePoS
create0.0315914058171786VB
exposure0NN
risk0.0631828116343571NN
level0.00692515656684925NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
child0.0273960270556257NN

Estimating the Cost of Environmental Health Risks Information Types and Sources Type of Information Source Source Level Exposure to risk factors for example access to water malnutrition indoor air pollution Demographic and Health Surveys DHSs Multiple Indicator Cluster Surveys MICSs national nutrition surveys national censuses Living Standards Measurement Surveys LSMSs Vital records health information systems and statistical estimates of cause specific mortality DHSs and MICSs WHO national estimates of cause specific mortality Example the relative risk of dying from different levels of malnutrition is summarized in Fishman and others Example the effect of diarrheal diseases on weight gain in children is analyzed in Checkley and others and Molbak and others For the human capital approach national accounts statistics for example gross domestic product economic indicators for example wage rate For willingness to pay approach value of statistical life studies benefit transfer approach Country specific sources Baseline health end points for example crude mortality rate disease specific mortality disease prevalence Relative risks of illness and mortality epidemiology literature Links between malnutrition and infections epidemiology literature Value of mortality and morbidity Cost of illness Economic indicators public health statistics interviews with hospitals and practitioners DHSs and MICSs treatment rates and type of treatment Country specific sources Typically international studies and meta analyses International studies and meta analyses For the human capital approach countryspecific sources For the willingness to pay approach international studies and meta analyses Country specific sources Source Compiled by World Bank team

Label: 3, with a score of: 0.718722801624727
WordScorePoS
estimate0.059903311017139NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
information0.00914534810831654NN
type0NN
source0NN
level0NN
exposure0NN
access0.00610236075888593NN
water0.0382775468083574NN
malnutrition0NN
air0.020806307400253NN
pollution0.0175975629039954NN
survey0NN
multiple0JJ
national0.00558382296134999JJ
nutrition0NN
live0.0300513417930436VB
standard0NN
measurement0NN
vital0JJ
record0NN
system0NN
statistical0JJ
specific0JJ
mortality0.276962203701274NN
relative0JJ
die0.0748292956291867VB
effect0NN
disease0.215415047323213NN
gain0NN
child0.10682408961305NN
human0JJ
approach0NN
account0NN
gross0JJ
domestic0JJ
product0NN
economic0JJ
wage0NN
rate0.0433561464459019NN
pay0NN
life0.0250390290383647NN
study0NN
benefit0NN
transfer0NN
country0NN
prevalence0.0407408489778079NN
illness0.0407408489778079NN
infection0.122222546933424NN
public0.021678073222951NN
treatment0.0624189222007589NN
typically0RB
international0JJ
world0.00087176582269799NN
bank0NN

Label: 6, with a score of: 0.299492813113095
WordScorePoS
estimate0NN
cost0NN
environmental0JJ
health0NN
risk0NN
information0NN
type0NN
source0.0613562156822703NN
level0.00647010760354177NN
exposure0NN
access0.00731085509381114NN
water0.556409482163189NN
malnutrition0.041835863322702NN
air0NN
pollution0.0590310971343993NN
survey0NN
multiple0JJ
national0JJ
nutrition0NN
live0.0252018374089947VB
standard0NN
measurement0NN
vital0JJ
record0NN
system0NN
statistical0JJ
specific0JJ
mortality0NN
relative0JJ
die0.0836717266454039VB
effect0NN
disease0.103230094596636NN
gain0.041835863322702NN
child0.0255958462813622NN
human0.0127979231406811JJ
approach0NN
account0.0181797964452808NN
gross0JJ
domestic0JJ
product0NN
economic0JJ
wage0NN
rate0NN
pay0.0295155485671997NN
life0NN
study0NN
benefit0NN
transfer0NN
country0NN
prevalence0NN
illness0NN
infection0NN
public0NN
treatment0.0348974218717993NN
typically0RB
international0.00301873916506525JJ
world0.00438651305628668NN
bank0NN

Label: 12, with a score of: 0.267281475274986
WordScorePoS
estimate0.0199423462679015NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
information0.0365348149782971NN
type0NN
source0NN
level0.00513687014008325NN
exposure0NN
access0.00232174891244877NN
water0.186896403054502NN
malnutrition0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
survey0NN
multiple0JJ
national0.00743561777158133JJ
nutrition0NN
live0VB
standard0.0409791940864438NN
measurement0NN
vital0JJ
record0NN
system0NN
statistical0JJ
specific0.0542519672965169JJ
mortality0NN
relative0JJ
die0VB
effect0NN
disease0NN
gain0.0664302389559493NN
child0NN
human0.0101607690729067JJ
approach0.0542519672965169NN
account0.0577345906651901NN
gross0JJ
domestic0JJ
product0.0199423462679015NN
economic0.0433009429988926JJ
wage0NN
rate0NN
pay0NN
life0.0250071479597636NN
study0NN
benefit0NN
transfer0NN
country0NN
prevalence0NN
illness0NN
infection0NN
public0.028867295332595NN
treatment0NN
typically0RB
international0.0023966944644375JJ
world0.00464349782489754NN
bank0NN

Label: 2, with a score of: 0.146014547864782
WordScorePoS
estimate0NN
cost0NN
environmental0JJ
health0NN
risk0.0252000451111224NN
information0.0130963126055467NN
type0NN
source0.0130963126055467NN
level0.00552410547653725NN
exposure0NN
access0.00749031153171887NN
water0NN
malnutrition0.0357189919948307NN
air0NN
pollution0NN
survey0NN
multiple0JJ
national0.00399807039435538JJ
nutrition0.175025014152344NN
live0.0143446978608332VB
standard0NN
measurement0NN
vital0JJ
record0NN
system0.0756001353333673NN
statistical0JJ
specific0JJ
mortality0NN
relative0JJ
die0VB
effect0.0440683498519077NN
disease0NN
gain0NN
child0.0546336178945768NN
human0JJ
approach0NN
account0NN
gross0JJ
domestic0JJ
product0NN
economic0JJ
wage0NN
rate0.0155217067874935NN
pay0NN
life0NN
study0NN
benefit0.0252000451111224NN
transfer0NN
country0NN
prevalence0NN
illness0NN
infection0NN
public0NN
treatment0NN
typically0RB
international0.00515473144367677JJ
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 8, with a score of: 0.116132238789901
WordScorePoS
estimate0NN
cost0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
information0NN
type0NN
source0NN
level0.00761994916892276NN
exposure0NN
access0.00344404437204141NN
water0NN
malnutrition0NN
air0NN
pollution0NN
survey0NN
multiple0JJ
national0.0055149369084567JJ
nutrition0NN
live0.00989353561471291VB
standard0NN
measurement0NN
vital0JJ
record0NN
system0NN
statistical0JJ
specific0JJ
mortality0NN
relative0JJ
die0VB
effect0NN
disease0NN
gain0NN
child0.0452169560888236NN
human0.0150723186962745JJ
approach0NN
account0NN
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN
economic0.128463821595706JJ
wage0NN
rate0NN
pay0.0695218668857431NN
life0.0123650647908625NN
study0NN
benefit0NN
transfer0NN
country0NN
prevalence0NN
illness0NN
infection0NN
public0NN
treatment0NN
typically0RB
international0.00355521737836969JJ
world0.00172202218602071NN
bank0NN

feasible and to compute the population shares that fall in each category

Label: 3, with a score of: 0.51630126863226
WordScorePoS
feasible0JJ
population0NN
share0NN
fall0.123094312756122NN

Label: 2, with a score of: 0.468318829022163
WordScorePoS
feasible0JJ
population0.0310434135749871NN
share0.0365427838531249NN
fall0.0440683498519077NN

Label: 10, with a score of: 0.360983152115456
WordScorePoS
feasible0JJ
population0.0860640399817412NN
share0NN
fall0NN

Label: 17, with a score of: 0.321388476780444
WordScorePoS
feasible0JJ
population0NN
share0.0766240489430275NN
fall0NN

Figure D

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

presents simplified illustration for ALRI mortality from indoor air pollution and malnutrition see table D

Label: 3, with a score of: 0.846116888799211
WordScorePoS
mortality0.276962203701274NN
air0.020806307400253NN
pollution0.0175975629039954NN
malnutrition0NN

In the case of diarrheal mortality relevant risk factors include lack of access to water sanitation or both and malnutrition

Label: 6, with a score of: 0.852826588224942
WordScorePoS
mortality0NN
relevant0JJ
risk0NN
include0VB
lack0.0214003646985842NN
access0.00731085509381114NN
water0.556409482163189NN
sanitation0.334686906581616NN
malnutrition0.041835863322702NN

Label: 3, with a score of: 0.369525632487307
WordScorePoS
mortality0.276962203701274NN
relevant0JJ
risk0.0703902516159815NN
include0VB
lack0NN
access0.00610236075888593NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
malnutrition0NN

Label: 12, with a score of: 0.192377995352392
WordScorePoS
mortality0NN
relevant0.0277064208763707JJ
risk0NN
include0VB
lack0NN
access0.00232174891244877NN
water0.186896403054502NN
sanitation0NN
malnutrition0NN

Exposure data can often be obtained from the Demographic and Health Surveys DHSs

Label: 3, with a score of: 0.651075132155405
WordScorePoS
exposure0NN
datum0NN
obtain0VB
health0.191387734041787NN
survey0NN

Label: 1, with a score of: 0.409129521883674
WordScorePoS
exposure0.120266261535276NN
datum0NN
obtain0VB
health0NN
survey0NN

Label: 10, with a score of: 0.357951613930399
WordScorePoS
exposure0NN
datum0NN
obtain0VB
health0.0405241466500776NN
survey0.064698038783335NN

Ghana DHS reports malnutrition levels for each child and this information can be overlaid with household characteristics to obtain exposure to indoor air pollution and lack of water and sanitation

Label: 6, with a score of: 0.810168658256893
WordScorePoS
report0NN
malnutrition0.041835863322702NN
level0.00647010760354177NN
child0.0255958462813622NN
information0NN
household0NN
characteristic0JJ
obtain0VB
exposure0NN
air0NN
pollution0.0590310971343993NN
lack0.0214003646985842NN
water0.556409482163189NN
sanitation0.334686906581616NN

Label: 12, with a score of: 0.312934850522757
WordScorePoS
report0.0409791940864438NN
malnutrition0NN
level0.00513687014008325NN
child0NN
information0.0365348149782971NN
household0.0554128417527413NN
characteristic0JJ
obtain0VB
exposure0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
lack0NN
water0.186896403054502NN
sanitation0NN

COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE FIGURE D

Label: 3, with a score of: 0.839835445885378
WordScorePoS
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
figure0NN

Exposure Categories Indoor air pollution No indoor air pollution Malnutrition Exposure category Exposure category No malnutrition Exposure category Exposure category Source Compiled by World Bank team

Label: 0, with a score of: 1

Step Assessment of Relative Risks Relative risks express the probability of an event for example developing disease or dying from disease occurring in the exposed group versus the probability of the same event occurring in the group that was not exposed

Label: 3, with a score of: 0.809086751195154
WordScorePoS
relative0JJ
risk0.0703902516159815NN
event0NN
develop0VB
disease0.215415047323213NN
die0.0748292956291867VB
occur0.0307735781890304VB

Relative risks typically are available from the epidemiology literature

Label: 11, with a score of: 0.823979964851217
WordScorePoS
relative0.0731385760866977JJ
risk0.0631828116343571NN
typically0RB

Label: 3, with a score of: 0.425466304459037
WordScorePoS
relative0JJ
risk0.0703902516159815NN
typically0RB

Label: 1, with a score of: 0.313992240775287
WordScorePoS
relative0JJ
risk0.0519476926891779NN
typically0RB

However current research literature does not contain estimates of the combined relative risk of multiple environmental risk factors such as the risk of death from exposure to indoor air pollution and from malnourishment with the latter partially caused by diarrheal infections from inadequate water sanitation and hygiene

Label: 6, with a score of: 0.732516236721782
WordScorePoS
current0JJ
research0NN
estimate0NN
relative0JJ
risk0NN
multiple0JJ
environmental0JJ
death0.0295155485671997NN
exposure0NN
air0NN
pollution0.0590310971343993NN
cause0NN
infection0NN
inadequate0.0836717266454039JJ
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN

Label: 3, with a score of: 0.431026953127564
WordScorePoS
current0JJ
research0.0175975629039954NN
estimate0.059903311017139NN
relative0JJ
risk0.0703902516159815NN
multiple0JJ
environmental0JJ
death0.193573191943949NN
exposure0NN
air0.020806307400253NN
pollution0.0175975629039954NN
cause0NN
infection0.122222546933424NN
inadequate0JJ
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN

Label: 12, with a score of: 0.231190407993844
WordScorePoS
current0.0332151194779746JJ
research0NN
estimate0.0199423462679015NN
relative0JJ
risk0NN
multiple0JJ
environmental0.0598270388037045JJ
death0NN
exposure0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
cause0NN
infection0NN
inadequate0JJ
water0.186896403054502NN
sanitation0NN
hygiene0NN

Label: 11, with a score of: 0.309847562773781
WordScorePoS
current0JJ
research0NN
estimate0NN
relative0.0731385760866977JJ
risk0.0631828116343571NN
multiple0JJ
environmental0.0537696560159885JJ
death0.0315914058171786NN
exposure0NN
air0.0373517915079663NN
pollution0.0315914058171786NN
cause0.04477822029736NN
infection0NN
inadequate0JJ
water0.0458109463416786NN
sanitation0NN
hygiene0NN

In this analysis the problem is overcome by assuming Cox proportional hazard model in the calculation of relative risks

Label: 11, with a score of: 0.887774932459883
WordScorePoS
overcome0.0731385760866977VBN
hazard0NN
relative0.0731385760866977JJ
risk0.0631828116343571NN

If that model is used the relative risk is calculated as RRi exp ENV MAL D

Label: 11, with a score of: 0.823979964851217
WordScorePoS
relative0.0731385760866977JJ
risk0.0631828116343571NN

where RR is relative risk ENV is binary variable that is one that takes value of either or indicating the presence of an environmental risk MAL is binary variable indicating the presence of malnutrition and and are the parameters linking the presence of risk factors to the relative risk of disease

Label: 3, with a score of: 0.635682834755192
WordScorePoS
relative0JJ
risk0.0703902516159815NN
environmental0JJ
malnutrition0NN
disease0.215415047323213NN

It is easy to see that equation D

Label: 0, with a score of: 1

implies that the relative risk for exposure category in figure D

Label: 1, with a score of: 0.715358704385439
WordScorePoS
relative0JJ
risk0.0519476926891779NN
exposure0.120266261535276NN
figure0NN

Label: 11, with a score of: 0.566264747472546
WordScorePoS
relative0.0731385760866977JJ
risk0.0631828116343571NN
exposure0NN
figure0NN

is equal to the product of the relative risks for exposure categories and that is RR RR RR

Label: 1, with a score of: 0.62960742318595
WordScorePoS
equal0.0376648791150643JJ
product0NN
relative0JJ
risk0.0519476926891779NN
exposure0.120266261535276NN

Label: 11, with a score of: 0.489596036427696
WordScorePoS
equal0JJ
product0.0268848280079943NN
relative0.0731385760866977JJ
risk0.0631828116343571NN
exposure0NN

Label: 5, with a score of: 0.342619526180804
WordScorePoS
equal0.114211783066808JJ
product0NN
relative0JJ
risk0NN
exposure0NN

Label: 8, with a score of: 0.328699031961517
WordScorePoS
equal0.0504071033101074JJ
product0.0591643007226199NN
relative0JJ
risk0NN
exposure0NN

The relative risks for exposure categories and are revealed in the epidemiology literature which has been adjusted for potential biases

Label: 1, with a score of: 0.704991824617181
WordScorePoS
relative0JJ
risk0.0519476926891779NN
exposure0.120266261535276NN
potential0NN

Label: 11, with a score of: 0.558058516782875
WordScorePoS
relative0.0731385760866977JJ
risk0.0631828116343571NN
exposure0NN
potential0NN

Table D

Label: 0, with a score of: 1

summarizes

Label: 0, with a score of: 1

The relative risks discussed in literature could overestimate the mortality from environmental risk factors if the effects of underweight on mortality in Fishman and others did not control for environmental factors or if the relative risks of mortality from environmental factors did not control for underweight status

Label: 3, with a score of: 0.818432950206094
WordScorePoS
relative0JJ
risk0.0703902516159815NN
mortality0.276962203701274NN
environmental0JJ
effect0NN
control0.020806307400253NN
status0NN

An alternative approach used to obtain the results in chapter is therefore applied to assess the potential magnitude of overestimation

Label: 9, with a score of: 0.643719114498968
WordScorePoS
alternative0.0602029956716497NN
approach0NN
obtain0VB
result0NN
potential0.0454743001434393NN

The approach uses relationships between least squares coefficients when variable is omitted from an equation

Label: 0, with a score of: 1

In the case of Ghana the following two equations are estimated by using the DHS MAL ENV D

Label: 0, with a score of: 1

ENV MAL D

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE D

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN

Relative Risks by Exposure Categories Assuming Cox Hazard Model Environmental Health Exposure Malnourished RR RR RR Not malnourished RR from literature adjusted No Environmental Health Exposure RR from literature adjusted for example Fishman and others RR Source Compiled by World Bank team

Label: 3, with a score of: 0.540975147399717
WordScorePoS
relative0JJ
risk0.0703902516159815NN
exposure0NN
hazard0NN
environmental0JJ
health0.191387734041787NN
source0NN
world0.00087176582269799NN
bank0NN

The estimated coefficients and are then used in the following equations to solve for gi where bi represents the biased estimators in equation D

Label: 0, with a score of: 1

Step Calculation of Counterfactual Exposure Categories The next step is to estimate the population in each exposure category in the absence of environmental risk factors

Label: 1, with a score of: 0.779677173020512
WordScorePoS
exposure0.120266261535276NN
estimate0NN
population0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN

This step is important because child malnutrition depends not only on environmental health risks but also on various nutritional factors such as maternal malnutrition and low protein energy intake

Label: 3, with a score of: 0.573875627021679
WordScorePoS
child0.10682408961305NN
malnutrition0NN
depend0VB
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
nutritional0JJ
maternal0.184641469134183JJ
protein0NN
energy0NN
intake0NN

Label: 7, with a score of: 0.513062895845663
WordScorePoS
child0NN
malnutrition0NN
depend0VB
environmental0JJ
health0NN
risk0NN
nutritional0JJ
maternal0JJ
protein0NN
energy0.494617163780726NN
intake0NN

Label: 12, with a score of: 0.236263375806626
WordScorePoS
child0NN
malnutrition0NN
depend0VB
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
nutritional0JJ
maternal0JJ
protein0NN
energy0.133960988253756NN
intake0NN

Therefore one needs to separate out the effects of nonenvironmental factors on malnutrition

Label: 2, with a score of: 0.638691647862007
WordScorePoS
effect0.0440683498519077NN
malnutrition0.0357189919948307NN

Label: 1, with a score of: 0.589415264970016
WordScorePoS
effect0NN
malnutrition0.0736315832425121NN

Because the main environmental health risk influencing malnutrition acts through diarrheal infections this analysis estimates malnutrition prevalence in counterfactual child population that has not suffered from repeated diarrheal infections

Label: 3, with a score of: 0.779850778645796
WordScorePoS
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
influence0NN
malnutrition0NN
infection0.122222546933424NN
estimate0.059903311017139NN
prevalence0.0407408489778079NN
child0.10682408961305NN
population0NN
suffer0VB

Label: 1, with a score of: 0.315209318995297
WordScorePoS
environmental0.0442083771593746JJ
health0NN
risk0.0519476926891779NN
influence0NN
malnutrition0.0736315832425121NN
infection0NN
estimate0NN
prevalence0NN
child0.0450489732120807NN
population0NN
suffer0VB

Estimation of the effect of diarrheal infections on nutritional status and consequent disease burden involves the following steps

Label: 3, with a score of: 0.819098204129526
WordScorePoS
effect0NN
infection0.122222546933424NN
nutritional0JJ
status0NN
disease0.215415047323213NN
burden0NN
involve0VB

Label: 2, with a score of: 0.355351929829074
WordScorePoS
effect0.0440683498519077NN
infection0NN
nutritional0.0583416713841148JJ
status0NN
disease0NN
burden0.0440683498519077NN
involve0VB

A weight gain retardation factor is specified for each child at age and is function of diarrheal infection dose from initial age

Label: 3, with a score of: 0.719087310531
WordScorePoS
gain0NN
child0.10682408961305NN
age0.0893142758861673NN
function0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.478077082735787
WordScorePoS
gain0NN
child0.0450489732120807NN
age0.112994637345193NN
function0NN
infection0NN

Label: 2, with a score of: 0.303011417890982
WordScorePoS
gain0NN
child0.0546336178945768NN
age0.0365427838531249NN
function0.0440683498519077NN
infection0NN

The counterfactual weight Wt of child at age is estimated that is the weight of the child if the child had not suffered weight gain retardation from repeated diarrheal infections

Label: 3, with a score of: 0.718735875143462
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN
estimate0.059903311017139NN
suffer0VB
gain0NN
infection0.122222546933424NN

The weight for age score WAZ for Wt and corresponding underweight malnutrition rates are calculated

Label: 1, with a score of: 0.79695388689331
WordScorePoS
age0.112994637345193NN
malnutrition0.0736315832425121NN
rate0.0639932865717261NN

Label: 3, with a score of: 0.421883395876516
WordScorePoS
age0.0893142758861673NN
malnutrition0NN
rate0.0433561464459019NN

Mortality from environmental factors is then estimated

Label: 3, with a score of: 0.918735572158447
WordScorePoS
mortality0.276962203701274NN
environmental0JJ
estimate0.059903311017139NN

The relationship between child observed weight the weight gain retardation factor and the counterfactual weight is Wt Di − i − βti WtNi − i D

Label: 0, with a score of: 1

COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE which gives Wt Ni − βti WtDi − βti − βti i D

Label: 3, with a score of: 0.859914684372597
WordScorePoS
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN

where Wt is the observed weight of child at age who has suffered weight gain retardation from diarrheal infections and is the initial weight of the child

Label: 3, with a score of: 0.708385331955801
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN
suffer0VB
gain0NN
infection0.122222546933424NN

Label: 1, with a score of: 0.338365197923314
WordScorePoS
child0.0450489732120807NN
age0.112994637345193NN
suffer0VB
gain0NN
infection0NN

Table D

Label: 0, with a score of: 1

presents the weight gain retardation factors for subset of age groups used in this study

Label: 1, with a score of: 0.605218302176034
WordScorePoS
gain0NN
age0.112994637345193NN
study0NN

Label: 3, with a score of: 0.478382299212784
WordScorePoS
gain0NN
age0.0893142758861673NN
study0NN

This factor is the reduction in weight gain from repeated infections over period of child life in his or her first five years

Label: 3, with a score of: 0.693331776106211
WordScorePoS
reduction0.0149758277542848NN
gain0NN
infection0.122222546933424NN
period0NN
child0.10682408961305NN
life0.0250390290383647NN

Label: 12, with a score of: 0.392606479429014
WordScorePoS
reduction0.0199423462679015NN
gain0.0664302389559493NN
infection0NN
period0.0409791940864438NN
child0NN
life0.0250071479597636NN

For instance if child initial weight was kilograms at the age of months and was kilograms at the age of months and if the child had suffered weight gain retardation of percent bti

Label: 3, with a score of: 0.600497726263674
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN
suffer0VB
gain0NN

during that period then the child weight would have been

Label: 3, with a score of: 0.543265540080431
WordScorePoS
period0NN
child0.10682408961305NN

Label: 2, with a score of: 0.501959604889012
WordScorePoS
period0.0440683498519077NN
child0.0546336178945768NN

Label: 4, with a score of: 0.388167010050637
WordScorePoS
period0NN
child0.076326555629389NN

Label: 16, with a score of: 0.307147298106613
WordScorePoS
period0NN
child0.0603953832457135NN

kilograms in the absence of the weight gain retardation

Label: 12, with a score of: 0.735021154461331
WordScorePoS
gain0.0664302389559493NN

In contrast the median child at months of age in the international reference population has weight of

Label: 3, with a score of: 0.523048311467928
WordScorePoS
child0.10682408961305NN
age0.0893142758861673NN
international0JJ
population0NN

Label: 1, with a score of: 0.435628219046552
WordScorePoS
child0.0450489732120807NN
age0.112994637345193NN
international0.00531301439641424JJ
population0NN

Label: 10, with a score of: 0.363413743338352
WordScorePoS
child0.0242343960710022NN
age0.0202620733250388NN
international0.00571634317201755JJ
population0.0860640399817412NN

Label: 2, with a score of: 0.339673686178474
WordScorePoS
child0.0546336178945768NN
age0.0365427838531249NN
international0.00515473144367677JJ
population0.0310434135749871NN

Label: 8, with a score of: 0.311466208813531
WordScorePoS
child0.0452169560888236NN
age0.0252035516550537NN
international0.00355521737836969JJ
population0.0428212738652355NN

kilograms

Label: 0, with a score of: 1

The share of the weight retardation from repeated infections is therefore percent

Label: 3, with a score of: 0.747295479367932
WordScorePoS
share0NN
infection0.122222546933424NN

Label: 17, with a score of: 0.468496253945537
WordScorePoS
share0.0766240489430275NN
infection0NN

The remaining weight retardation percent is from other factors

Label: 0, with a score of: 1

The factors in table D

Label: 0, with a score of: 1

are used to calculate Wt for each child in the DHS data set in Ghana along with new weight for age score for each child

Label: 3, with a score of: 0.591213769329719
WordScorePoS
child0.10682408961305NN
datum0NN
set0NN
age0.0893142758861673NN

Label: 1, with a score of: 0.396323471595506
WordScorePoS
child0.0450489732120807NN
datum0NN
set0NN
age0.112994637345193NN

Label: 17, with a score of: 0.365142247062632
WordScorePoS
child0NN
datum0.0739231123597559NN
set0.0978661089756501NN
age0.0153248097886055NN

The results imply that weight gain retardation from diarrheal infections is about percent of total weight retardation relative to the median child in the international reference population WAZ see appendix

Label: 3, with a score of: 0.517865619527873
WordScorePoS
result0NN
gain0NN
infection0.122222546933424NN
total0NN
relative0JJ
child0.10682408961305NN
international0JJ
population0NN

Label: 6, with a score of: 0.462724446571341
WordScorePoS
result0.0683326727248364NN
gain0.041835863322702NN
infection0NN
total0.0295155485671997NN
relative0JJ
child0.0255958462813622NN
international0.00301873916506525JJ
population0.0363595928905615NN

This result is equivalent to approximately percent change in the standard deviation

Label: 13, with a score of: 0.879872678498579
WordScorePoS
result0NN
equivalent0JJ
approximately0RB
change0.402565546215053NN
standard0NN

This change in standard deviation is applied to each of the children in the Ghana DHS for example the new score is

Label: 13, with a score of: 0.846953544922656
WordScorePoS
change0.402565546215053NN
standard0NN
child0NN

for an old score of

Label: 0, with a score of: 1

TABLE D

Label: 0, with a score of: 1

Weight Gain Retardation Factors by Age and Score Age Months WAZ

Label: 1, with a score of: 0.700029824766285
WordScorePoS
gain0NN
age0.112994637345193NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Note WAZ weight for age score

Label: 1, with a score of: 0.729188688443444
WordScorePoS
age0.112994637345193NN

Label: 3, with a score of: 0.576372129004236
WordScorePoS
age0.0893142758861673NN

WAZ

Label: 0, with a score of: 1

WAZ WAZ

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE D

Label: 3, with a score of: 0.763800712830639
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN

Weight for Age in Children under Five Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana Weight for Age Score > WAZ not underweight to WAZ mild underweight to WAZ moderate underweight < WAZ severe underweight Prevalence Rates in the Absence Prevalence of Weight Gain Retardation Rates in from Diarrheal Infections

Label: 3, with a score of: 0.75565907043766
WordScorePoS
age0.0893142758861673NN
child0.10682408961305NN
current0JJ
rate0.0433561464459019NN
estimate0.059903311017139NN
infection0.122222546933424NN
prevalence0.0407408489778079NN
gain0NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Note WAZ weight for age score

Label: 1, with a score of: 0.729188688443444
WordScorePoS
age0.112994637345193NN

Label: 3, with a score of: 0.576372129004236
WordScorePoS
age0.0893142758861673NN

Table D

Label: 0, with a score of: 1

presents current underweight prevalence rates in children under five from the DHS and estimated rates in the absence of weight gain retardation from diarrheal infections

Label: 3, with a score of: 0.754980831762551
WordScorePoS
current0JJ
prevalence0.0407408489778079NN
rate0.0433561464459019NN
child0.10682408961305NN
estimate0.059903311017139NN
gain0NN
infection0.122222546933424NN

In the absence of retardation from diarrheal infections the estimates indicate that there would be practically no severely underweight children in Ghana

Label: 3, with a score of: 0.873556578705289
WordScorePoS
infection0.122222546933424NN
estimate0.059903311017139NN
severely0RB
child0.10682408961305NN

Label: 4, with a score of: 0.321329474595229
WordScorePoS
infection0NN
estimate0.0299609328954485NN
severely0RB
child0.076326555629389NN

The prevalence of moderate underweight would also be substantially reduced while mild underweight would be about the same as reported in the DHS

Label: 0, with a score of: 1

Step Estimation of Deaths Attributable to Environmental Health Risk Factors The fraction of cause specific deaths attributable to environmental risk factors for example the fraction of ALRI mortality attributable to indoor air pollution and diarrhea related malnutrition are obtained by combining in equation D

Label: 3, with a score of: 0.83790083556907
WordScorePoS
death0.193573191943949NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
specific0JJ
mortality0.276962203701274NN
air0.020806307400253NN
pollution0.0175975629039954NN
related0.0125195145191824JJ
malnutrition0NN
obtain0VB

the parameters obtained in steps and

Label: 4, with a score of: 1
WordScorePoS
obtain0.0815069365350084VB

This procedure is undertaken for each cause of death for which environmental risks are contributing factor

Label: 3, with a score of: 0.70577185283606
WordScorePoS
undertake0VB
death0.193573191943949NN
environmental0JJ
risk0.0703902516159815NN
contribute0VB

Label: 11, with a score of: 0.397168954120032
WordScorePoS
undertake0VB
death0.0315914058171786NN
environmental0.0537696560159885JJ
risk0.0631828116343571NN
contribute0VB

Label: 12, with a score of: 0.308122454094531
WordScorePoS
undertake0VB
death0NN
environmental0.0598270388037045JJ
risk0NN
contribute0.0554128417527413VB

Figure D

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

explains using ALRI as an example

Label: 0, with a score of: 1

The left side of the figure presents child population shares and relative risks for the current situation and the right side presents the counterfactual situation that is no environmental health risks

Label: 3, with a score of: 0.524381911304698
WordScorePoS
figure0NN
child0.10682408961305NN
population0NN
share0NN
relative0JJ
risk0.0703902516159815NN
current0JJ
situation0NN
environmental0JJ
health0.191387734041787NN

Label: 11, with a score of: 0.536813266169494
WordScorePoS
figure0NN
child0.0273960270556257NN
population0.0194583992186006NN
share0NN
relative0.0731385760866977JJ
risk0.0631828116343571NN
current0JJ
situation0.0631828116343571NN
environmental0.0537696560159885JJ
health0.0229054731708393NN

Label: 1, with a score of: 0.354827754305656
WordScorePoS
figure0NN
child0.0450489732120807NN
population0NN
share0NN
relative0JJ
risk0.0519476926891779NN
current0JJ
situation0.0519476926891779NN
environmental0.0442083771593746JJ
health0NN

Combining this information in equation D

Label: 9, with a score of: 0.750008629339307
WordScorePoS
information0.0675706773907211NN

Label: 12, with a score of: 0.405522447948709
WordScorePoS
information0.0365348149782971NN

gives the impact fraction at the bottom of the figure

Label: 12, with a score of: 0.57191780701176
WordScorePoS
impact0.0866018859977851NN
bottom0NN
figure0NN

Label: 9, with a score of: 0.503355328558754
WordScorePoS
impact0.0160169090870187NN
bottom0NN
figure0.0602029956716497NN

Label: 10, with a score of: 0.427265065103468
WordScorePoS
impact0NN
bottom0.064698038783335NN
figure0NN

Table D

Label: 0, with a score of: 1

presents the cause specific mortality values of impact fraction and mortality attributable to environmental risk factors for each cause of death in Ghana

Label: 3, with a score of: 0.923143562796907
WordScorePoS
specific0JJ
mortality0.276962203701274NN
value0NN
impact0NN
environmental0JJ
risk0.0703902516159815NN
death0.193573191943949NN

Step Valuation of Attributable Health End Points The last step consists of multiplying each end point by its unit cost

Label: 3, with a score of: 0.774384343365677
WordScorePoS
health0.191387734041787NN
cost0NN

Label: 10, with a score of: 0.431346707341994
WordScorePoS
health0.0405241466500776NN
cost0.0660824365173543NN

Mortality can be valued by first estimating stream of income that the individual would have generated if he or she had been alive and then discounting the stream to obtain COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE FIGURE D

Label: 3, with a score of: 0.802489193210148
WordScorePoS
mortality0.276962203701274NN
value0NN
estimate0.059903311017139NN
income0NN
individual0JJ
generate0VB
obtain0VB
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
figure0NN

Label: 10, with a score of: 0.371585870014484
WordScorePoS
mortality0.0488696285210061NN
value0NN
estimate0NN
income0.166475342664294NN
individual0.064698038783335JJ
generate0VB
obtain0VB
country0NN
level0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN
disease0NN
figure0NN

Exposure Categories Population Shares and Relative Risks of ALRI in Ghana Current Situation Situation with no Environmental Health Risks Not Exposed to exposed to environmental environmental health risk health risk Population Population Not Exposed to exposed to environmental environmental health risk health risk Malnourished

Label: 3, with a score of: 0.635823349732224
WordScorePoS
exposure0NN
population0NN
share0NN
relative0JJ
risk0.0703902516159815NN
current0JJ
situation0NN
environmental0JJ
health0.191387734041787NN

Malnourished

Label: 0, with a score of: 1

Not malnourished

Label: 0, with a score of: 1

Not malnourished

Label: 0, with a score of: 1

Relative risks Not Exposed to exposed to environmental environmental health risk health risk Relative risks Not Exposed to exposed to environmental environmental health risk health risk Malnourished

Label: 3, with a score of: 0.720556941391967
WordScorePoS
relative0JJ
risk0.0703902516159815NN
environmental0JJ
health0.191387734041787NN

Label: 11, with a score of: 0.504723375187014
WordScorePoS
relative0.0731385760866977JJ
risk0.0631828116343571NN
environmental0.0537696560159885JJ
health0.0229054731708393NN

Not malnourished

Label: 0, with a score of: 1

Impact fraction

Label: 12, with a score of: 0.7540481934975
WordScorePoS
impact0.0866018859977851NN

Label: 13, with a score of: 0.380994623285423
WordScorePoS
impact0.0437569550806737NN

Label: 14, with a score of: 0.369701718692048
WordScorePoS
impact0.042459973210532NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

TABLE D

Label: 0, with a score of: 1

Estimated Mortality in Children under Five from Environmental Risk Factors Ghana Cause of Mortality Pneumonia ALRI Diarrhea Malaria Measles Protein energy malnutrition Other malnutrition related causes of mortality excluding perinatal conditions Total Mortality Impact Fraction Mortality Attributable to Environmental Health Risks

Label: 3, with a score of: 0.887035432005654
WordScorePoS
estimate0.059903311017139NN
mortality0.276962203701274NN
child0.10682408961305NN
environmental0JJ
risk0.0703902516159815NN
malaria0.20370424488904NN
measles0.0407408489778079NNS
protein0NN
energy0NN
malnutrition0NN
related0.0125195145191824JJ
condition0NN
total0NN
impact0NN
health0.191387734041787NN

Label: 7, with a score of: 0.226865657947156
WordScorePoS
estimate0NN
mortality0NN
child0NN
environmental0JJ
risk0NN
malaria0NN
measles0NNS
protein0NN
energy0.494617163780726NN
malnutrition0NN
related0JJ
condition0NN
total0.0528748274225028NN
impact0NN
health0NN

Label: 12, with a score of: 0.203176171690617
WordScorePoS
estimate0.0199423462679015NN
mortality0NN
child0NN
environmental0.0598270388037045JJ
risk0NN
malaria0NN
measles0NNS
protein0NN
energy0.133960988253756NN
malnutrition0NN
related0.00833571598658786JJ
condition0.0409791940864438NN
total0.0468670845659596NN
impact0.0866018859977851NN
health0.0339811641917276NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Note Not including perinatal conditions

Label: 8, with a score of: 0.947616466099916
WordScorePoS
include0VB
condition0.121575732851624NN

Label: 12, with a score of: 0.3194104462542
WordScorePoS
include0VB
condition0.0409791940864438NN

ALRI acute lower respiratory infection

Label: 3, with a score of: 1
WordScorePoS
infection0.122222546933424NN

measure of lost productivity

Label: 2, with a score of: 0.602725305394638
WordScorePoS
measure0.0504000902222448NN
lose0.0440683498519077VB
productivity0.0595900566394012NN

Label: 1, with a score of: 0.406471432716206
WordScorePoS
measure0.103895385378356NN
lose0VB
productivity0NN

Label: 15, with a score of: 0.39318922883748
WordScorePoS
measure0.0223459295604043NN
lose0.0781544824456958VB
productivity0NN

Label: 9, with a score of: 0.360859433135564
WordScorePoS
measure0NN
lose0VB
productivity0.0922368138456871NN

This method the human capital approach is often considered to provide lower bound estimate of the value of avoiding mortality see appendix

Label: 3, with a score of: 0.864075902153055
WordScorePoS
human0JJ
approach0NN
provide0.0100171139310145VB
estimate0.059903311017139NN
avoid0VB
mortality0.276962203701274NN

Applying the human capital approach to valuation of mortality suggests cost in Ghana equivalent to

Label: 3, with a score of: 0.758969939614269
WordScorePoS
human0JJ
approach0NN
mortality0.276962203701274NN
suggest0VB
cost0NN
equivalent0JJ

Label: 12, with a score of: 0.434478871315258
WordScorePoS
human0.0101607690729067JJ
approach0.0542519672965169NN
mortality0NN
suggest0VB
cost0.0277064208763707NN
equivalent0.0664302389559493JJ

Label: 10, with a score of: 0.315007465620836
WordScorePoS
human0JJ
approach0NN
mortality0.0488696285210061NN
suggest0VB
cost0.0660824365173543NN
equivalent0JJ

percent of gross domestic product GDP for the effect of environmental factors

Label: 8, with a score of: 0.559684777064223
WordScorePoS
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN
gdp0NN
effect0NN
environmental0.0295821503613099JJ

Label: 9, with a score of: 0.546350076826721
WordScorePoS
gross0.030745604615229JJ
domestic0.0520080474473126JJ
product0.0442597400933733NN
gdp0NN
effect0.0454743001434393NN
environmental0.0221298700466866JJ

Label: 11, with a score of: 0.419965720014877
WordScorePoS
gross0.0373517915079663JJ
domestic0.0315914058171786JJ
product0.0268848280079943NN
gdp0NN
effect0NN
environmental0.0537696560159885JJ

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Education The health links between malnutrition and the environment provide further insight into the issue of costing environmental health risks

Label: 3, with a score of: 0.682465026899865
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
education0.0152605842304358NN
malnutrition0NN
environment0NN
provide0.0100171139310145VB
issue0.0249430985430622NN
cost0NN
risk0.0703902516159815NN

Label: 4, with a score of: 0.306967447858791
WordScorePoS
environmental0JJ
health0NN
child0.076326555629389NN
education0.244244978014045NN
malnutrition0NN
environment0.0299609328954485NN
provide0.0100202166857628VB
issue0NN
cost0NN
risk0NN

Label: 12, with a score of: 0.30585229390893
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
education0.0101607690729067NN
malnutrition0NN
environment0.079769385071606NN
provide0.0200087191734851VB
issue0NN
cost0.0277064208763707NN
risk0NN

Repeated infections in early childhood contribute to child malnutrition which in turn impairs cognitive development and educational performance

Label: 3, with a score of: 0.542604251078981
WordScorePoS
infection0.122222546933424NN
childhood0NN
contribute0VB
child0.10682408961305NN
malnutrition0NN
development0.00837573444202498NN
educational0JJ
performance0NN

Label: 4, with a score of: 0.424538117929008
WordScorePoS
infection0NN
childhood0.0815069365350084NN
contribute0VB
child0.076326555629389NN
malnutrition0NN
development0.0279277626235394NN
educational0JJ
performance0NN

Label: 2, with a score of: 0.311133693552832
WordScorePoS
infection0NN
childhood0NN
contribute0.0297950283197006VB
child0.0546336178945768NN
malnutrition0.0357189919948307NN
development0.0159922815774215NN
educational0JJ
performance0NN

Label: 6, with a score of: 0.310275441568823
WordScorePoS
infection0NN
childhood0NN
contribute0VB
child0.0255958462813622NN
malnutrition0.041835863322702NN
development0NN
educational0.0683326727248364JJ
performance0NN

Label: 1, with a score of: 0.308903107123324
WordScorePoS
infection0NN
childhood0NN
contribute0VB
child0.0450489732120807NN
malnutrition0.0736315832425121NN
development0.0164833460638534NN
educational0JJ
performance0NN

This effect has an impact on labor productivity reducing individual earnings

Label: 9, with a score of: 0.565168179203948
WordScorePoS
effect0.0454743001434393NN
impact0.0160169090870187NN
productivity0.0922368138456871NN
reduce0VB
individual0JJ

Label: 2, with a score of: 0.410488575364253
WordScorePoS
effect0.0440683498519077NN
impact0NN
productivity0.0595900566394012NN
reduce0.00799614078871077VB
individual0JJ

Label: 12, with a score of: 0.400393842742461
WordScorePoS
effect0NN
impact0.0866018859977851NN
productivity0NN
reduce0.022306853314744VB
individual0JJ

Label: 10, with a score of: 0.351956843372226
WordScorePoS
effect0NN
impact0NN
productivity0NN
reduce0.0310356414389692VB
individual0.064698038783335JJ

Malnutrition can also lead to delayed primary school enrollment and grade repetition which in turn may have an impact on lifetime income in terms of delayed labor force entry

Label: 4, with a score of: 0.550728828448454
WordScorePoS
malnutrition0NN
lead0.0255262687343935NN
primary0.108423939529757JJ
school0.208127520578185NN
impact0NN
income0NN
term0NN
force0NN

Label: 10, with a score of: 0.331788542002263
WordScorePoS
malnutrition0NN
lead0NN
primary0JJ
school0NN
impact0NN
income0.166475342664294NN
term0.0396106020715138NN
force0NN

Label: 17, with a score of: 0.270118720832094
WordScorePoS
malnutrition0NN
lead0NN
primary0JJ
school0NN
impact0NN
income0.017987180284335NN
term0.149793392961411NN
force0NN

Label: 5, with a score of: 0.38108723808656
WordScorePoS
malnutrition0NN
lead0NN
primary0.0970239057629001JJ
school0.0931221694711702NN
impact0NN
income0NN
term0NN
force0.0465610847355851NN

To value the impacts of malnutrition through education one needs to estimate the loss in education performance attributable to malnutrition estimate the relationship between education and lifetime income and combine this information to obtain the loss in lifetime income attributable to malnutrition

Label: 4, with a score of: 0.699335373510204
WordScorePoS
impact0NN
malnutrition0NN
education0.244244978014045NN
estimate0.0299609328954485NN
loss0NN
performance0NN
income0NN
information0.0182963616752599NN
obtain0.0815069365350084VB

Label: 10, with a score of: 0.340084419807982
WordScorePoS
impact0NN
malnutrition0NN
education0.0121171980355011NN
estimate0NN
loss0NN
performance0.064698038783335NN
income0.166475342664294NN
information0NN
obtain0VB

Label: 9, with a score of: 0.326604610107893
WordScorePoS
impact0.0160169090870187NN
malnutrition0NN
education0.022550656390892NN
estimate0.0221298700466866NN
loss0NN
performance0NN
income0.110649350233433NN
information0.0675706773907211NN
obtain0VB

The discussion here begins with the data collection issues

Label: 17, with a score of: 0.927103700614022
WordScorePoS
datum0.0739231123597559NN
collection0.048933054487825NN
issue0.0299586785922821NN

Step Data Collection Stunting an indicator of chronic malnutrition is often used when measuring the effects of malnutrition on education

Label: 4, with a score of: 0.462736089020478
WordScorePoS
datum0NN
collection0NN
stunt0NN
chronic0JJ
malnutrition0NN
measure0NN
effect0NN
education0.244244978014045NN

Label: 2, with a score of: 0.535382485913586
WordScorePoS
datum0NN
collection0NN
stunt0.11668334276823NN
chronic0JJ
malnutrition0.0357189919948307NN
measure0.0504000902222448NN
effect0.0440683498519077NN
education0NN

Label: 1, with a score of: 0.518508179297338
WordScorePoS
datum0NN
collection0NN
stunt0NN
chronic0JJ
malnutrition0.0736315832425121NN
measure0.103895385378356NN
effect0NN
education0.0225244866060403NN

Stunting is expressed as deviations from the median height for age score HAZ in an international reference population

Label: 1, with a score of: 0.678820992272867
WordScorePoS
stunt0NN
height0.120266261535276NN
age0.112994637345193NN
international0.00531301439641424JJ
population0NN

Label: 2, with a score of: 0.538974149642293
WordScorePoS
stunt0.11668334276823NN
height0NN
age0.0365427838531249NN
international0.00515473144367677JJ
population0.0310434135749871NN

Label: 10, with a score of: 0.318797518299318
WordScorePoS
stunt0NN
height0NN
age0.0202620733250388NN
international0.00571634317201755JJ
population0.0860640399817412NN

Mild stunting means an HAZ between and standard deviations from the median child in the reference population < HAZ <

Label: 2, with a score of: 0.579000040562432
WordScorePoS
stunt0.11668334276823NN
means0NNS
standard0NN
child0.0546336178945768NN
population0.0310434135749871NN

Label: 1, with a score of: 0.473005290610057
WordScorePoS
stunt0NN
means0.120266261535276NNS
standard0NN
child0.0450489732120807NN
population0NN

Moderate stunting is defined as < HAZ < and severe stunting as HAZ <

Label: 2, with a score of: 1
WordScorePoS
stunt0.11668334276823NN

The current stunting prevalence rate in Ghana is presented in table D

Label: 2, with a score of: 0.685228319420142
WordScorePoS
current0JJ
stunt0.11668334276823NN
prevalence0NN
rate0.0155217067874935NN

Label: 3, with a score of: 0.435880800590627
WordScorePoS
current0JJ
stunt0NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN

Label: 1, with a score of: 0.331681825762889
WordScorePoS
current0JJ
stunt0NN
prevalence0NN
rate0.0639932865717261NN

row

Label: 0, with a score of: 1

Step Assessment of Counterfactual Malnutrition Attributable Loss in School Performance To assess the loss in school performance attributable to malnutrition one first needs to establish the counterfactual situation

Label: 4, with a score of: 0.719524871665303
WordScorePoS
malnutrition0NN
loss0NN
school0.208127520578185NN
performance0NN
establish0VB
situation0.0352060273355634NN

Table D

Label: 0, with a score of: 1

provides the counterfactual prevalence rates achievable by controlling for diarrheal infections

Label: 3, with a score of: 0.821515031075703
WordScorePoS
prevalence0.0407408489778079NN
rate0.0433561464459019NN
control0.020806307400253NN
infection0.122222546933424NN

Label: 1, with a score of: 0.453619772384789
WordScorePoS
prevalence0NN
rate0.0639932865717261NN
control0.0614198493690006NN
infection0NN

The share of severely malnourished children would go down from

Label: 3, with a score of: 0.481176480866375
WordScorePoS
share0NN
severely0RB
child0.10682408961305NN

Label: 2, with a score of: 0.410693321047112
WordScorePoS
share0.0365427838531249NN
severely0RB
child0.0546336178945768NN

Label: 17, with a score of: 0.345143968497108
WordScorePoS
share0.0766240489430275NN
severely0RB
child0NN

Label: 4, with a score of: 0.343803945041197
WordScorePoS
share0NN
severely0RB
child0.076326555629389NN

Label: 8, with a score of: 0.317200850667326
WordScorePoS
share0.0252035516550537NN
severely0RB
child0.0452169560888236NN

percent current situation to

Label: 11, with a score of: 0.560062660565264
WordScorePoS
current0JJ
situation0.0631828116343571NN

Label: 1, with a score of: 0.46047274923592
WordScorePoS
current0JJ
situation0.0519476926891779NN

Label: 4, with a score of: 0.312071919996153
WordScorePoS
current0JJ
situation0.0352060273355634NN

percent situation without infections

Label: 3, with a score of: 0.782856361030429
WordScorePoS
situation0NN
infection0.122222546933424NN

Label: 11, with a score of: 0.404696737523291
WordScorePoS
situation0.0631828116343571NN
infection0NN

Label: 1, with a score of: 0.33273387507404
WordScorePoS
situation0.0519476926891779NN
infection0NN

Changes in prevalence rates are estimated by assuming percent change in standard deviation consistent with the literature analyzed in appendix and somewhat more conservative than the change used for underweight rates in table D

Label: 13, with a score of: 0.859957147870729
WordScorePoS
prevalence0NN
rate0NN
estimate0NN
change0.402565546215053NN
standard0NN
consistent0JJ
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The percent change in standard deviation is arrived at in way similar to that described in step

Label: 13, with a score of: 0.934180248704157
WordScorePoS
change0.402565546215053NN
standard0NN

The effect of nonenvironmental factors on malnutrition first needs to be separated through computations of the malnutrition prevalence of counterfactual child population that has not suffered from repeated diarrheal infections

Label: 3, with a score of: 0.545584069405322
WordScorePoS
effect0NN
malnutrition0NN
prevalence0.0407408489778079NN
child0.10682408961305NN
population0NN
suffer0VB
infection0.122222546933424NN

Label: 2, with a score of: 0.479081347674551
WordScorePoS
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
prevalence0NN
child0.0546336178945768NN
population0.0310434135749871NN
suffer0.0357189919948307VB
infection0NN

The estimation of the effect of diarrheal infections on stunting involves the actions described in step

Label: 2, with a score of: 0.647112432693169
WordScorePoS
effect0.0440683498519077NN
infection0NN
stunt0.11668334276823NN
involve0VB
action0NN

Label: 3, with a score of: 0.492011800229936
WordScorePoS
effect0NN
infection0.122222546933424NN
stunt0NN
involve0VB
action0NN

Label: 12, with a score of: 0.378950927090088
WordScorePoS
effect0NN
infection0NN
stunt0NN
involve0.0819583881728876VB
action0.0121782716594324NN

A smaller retardation factor is used for height for age than for weight for age because it appears from the research literature COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE TABLE D

Label: 3, with a score of: 0.748109717842322
WordScorePoS
height0NN
age0.0893142758861673NN
research0.0175975629039954NN
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN

Label: 1, with a score of: 0.498531530349025
WordScorePoS
height0.120266261535276NN
age0.112994637345193NN
research0NN
country0NN
level0.0113874611101829NN
environmental0.0442083771593746JJ
health0NN
burden0NN
disease0NN

Estimated Annual Cost of Education Outcomes from Stunting and Share from Environmental Factors in Ghana > Standard Deviations to to Nutritional status prevalence rate

Label: 4, with a score of: 0.555173195962774
WordScorePoS
estimate0.0299609328954485NN
cost0NN
education0.244244978014045NN
outcome0.0416255041156371NN
stunt0NN
share0NN
environmental0JJ
standard0NN
nutritional0JJ
status0NN
prevalence0NN
rate0.0216847879059514NN

Label: 2, with a score of: 0.373534677892949
WordScorePoS
estimate0NN
cost0NN
education0NN
outcome0NN
stunt0.11668334276823NN
share0.0365427838531249NN
environmental0JJ
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nutritional0.0583416713841148JJ
status0NN
prevalence0NN
rate0.0155217067874935NN

Label: 10, with a score of: 0.330794112162528
WordScorePoS
estimate0NN
cost0.0660824365173543NN
education0.0121171980355011NN
outcome0.0330412182586772NN
stunt0NN
share0NN
environmental0.0237821918091848JJ
standard0NN
nutritional0JJ
status0.0488696285210061NN
prevalence0NN
rate0.0172128079963482NN

Percentage of children < years stunted height for age standard deviation current situation

Label: 1, with a score of: 0.620422019115863
WordScorePoS
percentage0NN
child0.0450489732120807NN
stunt0NN
height0.120266261535276NN
age0.112994637345193NN
standard0NN
current0JJ
situation0.0519476926891779NN

Label: 2, with a score of: 0.547426923992944
WordScorePoS
percentage0.0583416713841148NN
child0.0546336178945768NN
stunt0.11668334276823NN
height0NN
age0.0365427838531249NN
standard0NN
current0JJ
situation0.0252000451111224NN

Label: 3, with a score of: 0.368465627212917
WordScorePoS
percentage0NN
child0.10682408961305NN
stunt0NN
height0NN
age0.0893142758861673NN
standard0NN
current0JJ
situation0NN

Percentage of children < years stunted height for age < standard deviation counterfactual situation

Label: 1, with a score of: 0.627111478372741
WordScorePoS
percentage0NN
child0.0450489732120807NN
stunt0NN
height0.120266261535276NN
age0.112994637345193NN
standard0NN
situation0.0519476926891779NN

Label: 2, with a score of: 0.553329342010583
WordScorePoS
percentage0.0583416713841148NN
child0.0546336178945768NN
stunt0.11668334276823NN
height0NN
age0.0365427838531249NN
standard0NN
situation0.0252000451111224NN

Label: 3, with a score of: 0.372438464612069
WordScorePoS
percentage0NN
child0.10682408961305NN
stunt0NN
height0NN
age0.0893142758861673NN
standard0NN
situation0NN

Standard deviation of median child in each nutrition bracket n

Label: 2, with a score of: 0.793657212528333
WordScorePoS
standard0NN
child0.0546336178945768NN
nutrition0.175025014152344NN

Label: 3, with a score of: 0.369164043334756
WordScorePoS
standard0NN
child0.10682408961305NN
nutrition0NN

Effects of malnutrition on education outcomes years per malnourished child

Label: 4, with a score of: 0.75938926251662
WordScorePoS
effect0NN
malnutrition0NN
education0.244244978014045NN
outcome0.0416255041156371NN
child0.076326555629389NN

Loss in grade attainment

Label: 15, with a score of: 0.715545800001805
WordScorePoS
loss0.0670377886812128NN

Label: 12, with a score of: 0.500248384966494
WordScorePoS
loss0.0468670845659596NN

Label: 11, with a score of: 0.337199334783096
WordScorePoS
loss0.0315914058171786NN

Loss in learning productivity grade equivalents

Label: 4, with a score of: 0.74158224914125
WordScorePoS
loss0NN
learn0.244520809605025VB
productivity0NN
equivalent0JJ

Label: 12, with a score of: 0.343607908606133
WordScorePoS
loss0.0468670845659596NN
learn0VB
productivity0NN
equivalent0.0664302389559493JJ

Delayed labor force participation

Label: 5, with a score of: 0.663716147614536
WordScorePoS
force0.0465610847355851NN
participation0.0465610847355851NN

Label: 1, with a score of: 0.437761985591184
WordScorePoS
force0NN
participation0.0614198493690006NN

Label: 16, with a score of: 0.391260162811644
WordScorePoS
force0NN
participation0.0548954478802642NN

Present value of lifetime income US thousands per child

Label: 10, with a score of: 0.610105681081788
WordScorePoS
income0.166475342664294NN
child0.0242343960710022NN

Label: 2, with a score of: 0.38060278037423
WordScorePoS
income0.0643370113878709NN
child0.0546336178945768NN

Label: 9, with a score of: 0.353981907967094
WordScorePoS
income0.110649350233433NN
child0NN

Label: 3, with a score of: 0.34174439324136
WordScorePoS
income0NN
child0.10682408961305NN

Income at current malnutrition rates

Label: 10, with a score of: 0.554856220185782
WordScorePoS
income0.166475342664294NN
current0JJ
malnutrition0NN
rate0.0172128079963482NN

Label: 1, with a score of: 0.549253219421214
WordScorePoS
income0.0442083771593746NN
current0JJ
malnutrition0.0736315832425121NN
rate0.0639932865717261NN

Label: 2, with a score of: 0.349118934303164
WordScorePoS
income0.0643370113878709NN
current0JJ
malnutrition0.0357189919948307NN
rate0.0155217067874935NN

Label: 9, with a score of: 0.334232121210474
WordScorePoS
income0.110649350233433NN
current0JJ
malnutrition0NN
rate0NN

Counterfactual income

Label: 10, with a score of: 0.756711939782219
WordScorePoS
income0.166475342664294NN

Label: 9, with a score of: 0.502955471427553
WordScorePoS
income0.110649350233433NN

Present value of lifetime income for birth cohort US million

Label: 10, with a score of: 0.762304153716186
WordScorePoS
income0.166475342664294NN
birth0.0396106020715138NN

Label: 9, with a score of: 0.409287782323408
WordScorePoS
income0.110649350233433NN
birth0NN

Labor force participation of population age

Label: 1, with a score of: 0.554956877904504
WordScorePoS
force0NN
participation0.0614198493690006NN
population0NN
age0.112994637345193NN

Label: 5, with a score of: 0.373477058108292
WordScorePoS
force0.0465610847355851NN
participation0.0465610847355851NN
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age0NN

Label: 3, with a score of: 0.350384742947396
WordScorePoS
force0.020806307400253NN
participation0NN
population0NN
age0.0893142758861673NN

Label: 8, with a score of: 0.34721403208945
WordScorePoS
force0.0410992516792148NN
participation0NN
population0.0428212738652355NN
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Label: 10, with a score of: 0.338311392545866
WordScorePoS
force0NN
participation0NN
population0.0860640399817412NN
age0.0202620733250388NN

Label: 2, with a score of: 0.309850299855408
WordScorePoS
force0.0297950283197006NN
participation0NN
population0.0310434135749871NN
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Present value of lifetime income for birth cohort US million current malnutrition rates

Label: 10, with a score of: 0.577198364321698
WordScorePoS
income0.166475342664294NN
birth0.0396106020715138NN
current0JJ
malnutrition0NN
rate0.0172128079963482NN

Label: 1, with a score of: 0.470015400660852
WordScorePoS
income0.0442083771593746NN
birth0NN
current0JJ
malnutrition0.0736315832425121NN
rate0.0639932865717261NN

Label: 16, with a score of: 0.317953274018011
WordScorePoS
income0NN
birth0.0658099748168827NN
current0JJ
malnutrition0NN
rate0.0571955184484387NN

Label: 3, with a score of: 0.305494065764903
WordScorePoS
income0NN
birth0.0748292956291867NN
current0JJ
malnutrition0NN
rate0.0433561464459019NN

Present value of lifetime income for birth cohort US million counterfactual income

Label: 10, with a score of: 0.774368040656922
WordScorePoS
income0.166475342664294NN
birth0.0396106020715138NN

Label: 9, with a score of: 0.459968995373414
WordScorePoS
income0.110649350233433NN
birth0NN

Present value of lifetime income for birth cohort US million current malnutrition rates

Label: 10, with a score of: 0.577198364321698
WordScorePoS
income0.166475342664294NN
birth0.0396106020715138NN
current0JJ
malnutrition0NN
rate0.0172128079963482NN

Label: 1, with a score of: 0.470015400660852
WordScorePoS
income0.0442083771593746NN
birth0NN
current0JJ
malnutrition0.0736315832425121NN
rate0.0639932865717261NN

Label: 16, with a score of: 0.317953274018011
WordScorePoS
income0NN
birth0.0658099748168827NN
current0JJ
malnutrition0NN
rate0.0571955184484387NN

Label: 3, with a score of: 0.305494065764903
WordScorePoS
income0NN
birth0.0748292956291867NN
current0JJ
malnutrition0NN
rate0.0433561464459019NN

Present value of lifetime income for birth cohort US million counterfactual income

Label: 10, with a score of: 0.774368040656922
WordScorePoS
income0.166475342664294NN
birth0.0396106020715138NN

Label: 9, with a score of: 0.459968995373414
WordScorePoS
income0.110649350233433NN
birth0NN

Total cost of environmental factors US million

Label: 12, with a score of: 0.653662834497638
WordScorePoS
total0.0468670845659596NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ

Label: 10, with a score of: 0.437060489617291
WordScorePoS
total0NN
cost0.0660824365173543NN
environmental0.0237821918091848JJ

Total cost of environmental factors of gross domestic product in

Label: 8, with a score of: 0.518257707169348
WordScorePoS
total0NN
cost0NN
environmental0.0295821503613099JJ
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN

Label: 9, with a score of: 0.455296871908189
WordScorePoS
total0.0260040237236563NN
cost0NN
environmental0.0221298700466866JJ
gross0.030745604615229JJ
domestic0.0520080474473126JJ
product0.0442597400933733NN

Label: 12, with a score of: 0.40121566760589
WordScorePoS
total0.0468670845659596NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
gross0JJ
domestic0JJ
product0.0199423462679015NN

Label: 11, with a score of: 0.388880455684896
WordScorePoS
total0NN
cost0NN
environmental0.0537696560159885JJ
gross0.0373517915079663JJ
domestic0.0315914058171786JJ
product0.0268848280079943NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Note n

Label: 0, with a score of: 1

not applicable

Label: 17, with a score of: 1
WordScorePoS
applicable0.048933054487825JJ

From delayed primary school enrollment and grade repetition

Label: 4, with a score of: 0.82796501139059
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN

Label: 5, with a score of: 0.497341877031206
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN

Present value of lifetime income losses of an annual national birth cohort adjusted for child mortality discounted to childhood age year

Label: 3, with a score of: 0.732366343266327
WordScorePoS
income0NN
loss0NN
national0.00558382296134999JJ
birth0.0748292956291867NN
child0.10682408961305NN
mortality0.276962203701274NN
childhood0NN
age0.0893142758861673NN

Label: 10, with a score of: 0.407944254407627
WordScorePoS
income0.166475342664294NN
loss0NN
national0.00886732612541978JJ
birth0.0396106020715138NN
child0.0242343960710022NN
mortality0.0488696285210061NN
childhood0NN
age0.0202620733250388NN

<

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL see appendix that height growth retardation from infections is somewhat less than weight gain retardation table D

Label: 3, with a score of: 0.628893423922144
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
height0NN
growth0NN
infection0.122222546933424NN
gain0NN

Label: 8, with a score of: 0.423862113418803
WordScorePoS
environmental0.0295821503613099JJ
health0NN
child0.0452169560888236NN
height0NN
growth0.208565600657229NN
infection0NN
gain0NN

Label: 1, with a score of: 0.391113561373762
WordScorePoS
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
height0.120266261535276NN
growth0.0519476926891779NN
infection0NN
gain0NN

Using the factors in table D

Label: 0, with a score of: 1

one can calculate the counterfactual height in the absence of growth retardation from infections for each child in the DHS data sets in Ghana along with new height for age score for each child

Label: 8, with a score of: 0.391271201965059
WordScorePoS
height0NN
growth0.208565600657229NN
infection0NN
child0.0452169560888236NN
datum0NN
set0NN
age0.0252035516550537NN

Label: 1, with a score of: 0.598092325987117
WordScorePoS
height0.120266261535276NN
growth0.0519476926891779NN
infection0NN
child0.0450489732120807NN
datum0NN
set0NN
age0.112994637345193NN

Label: 3, with a score of: 0.513143350664105
WordScorePoS
height0NN
growth0NN
infection0.122222546933424NN
child0.10682408961305NN
datum0NN
set0NN
age0.0893142758861673NN

The results imply that height growth retardation from diarrheal infections is percent of total height retardation relative to the median child in the international reference population HAZ see appendix

Label: 8, with a score of: 0.475538053263514
WordScorePoS
result0NN
height0NN
growth0.208565600657229NN
infection0NN
total0NN
relative0JJ
child0.0452169560888236NN
international0.00355521737836969JJ
population0.0428212738652355NN

Label: 1, with a score of: 0.543160417979193
WordScorePoS
result0NN
height0.120266261535276NN
growth0.0519476926891779NN
infection0NN
total0NN
relative0JJ
child0.0450489732120807NN
international0.00531301439641424JJ
population0NN

Label: 3, with a score of: 0.362875590055905
WordScorePoS
result0NN
height0NN
growth0NN
infection0.122222546933424NN
total0NN
relative0JJ
child0.10682408961305NN
international0JJ
population0NN

Label: 10, with a score of: 0.360896143750199
WordScorePoS
result0NN
height0NN
growth0.11178243319132NN
infection0NN
total0NN
relative0JJ
child0.0242343960710022NN
international0.00571634317201755JJ
population0.0860640399817412NN

The new scores are percent higher than observed scores for example the new score is

Label: 0, with a score of: 1

for an old score of

Label: 0, with a score of: 1

Table D

Label: 0, with a score of: 1

presents current height for age prevalence rates in children under five from the DHS and estimated rates in the absence of height growth retardation from diarrheal infections

Label: 8, with a score of: 0.310960204089872
WordScorePoS
current0JJ
height0NN
age0.0252035516550537NN
prevalence0NN
rate0NN
child0.0452169560888236NN
estimate0NN
growth0.208565600657229NN
infection0NN

Label: 1, with a score of: 0.644812434982239
WordScorePoS
current0JJ
height0.120266261535276NN
age0.112994637345193NN
prevalence0NN
rate0.0639932865717261NN
child0.0450489732120807NN
estimate0NN
growth0.0519476926891779NN
infection0NN

Label: 3, with a score of: 0.563676722230972
WordScorePoS
current0JJ
height0NN
age0.0893142758861673NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
child0.10682408961305NN
estimate0.059903311017139NN
growth0NN
infection0.122222546933424NN

In the absence of height retardation from diarrheal infections the estimates indicate more than percent reduction in the number TABLE D

Label: 3, with a score of: 0.786961254095683
WordScorePoS
height0NN
infection0.122222546933424NN
estimate0.059903311017139NN
reduction0.0149758277542848NN

Label: 1, with a score of: 0.480183046962507
WordScorePoS
height0.120266261535276NN
infection0NN
estimate0NN
reduction0NN

Height Growth Retardation Factors by Age and Score Age Months HAZ HAZ HAZ

Label: 8, with a score of: 0.477114661046595
WordScorePoS
height0NN
growth0.208565600657229NN
age0.0252035516550537NN

Label: 1, with a score of: 0.733624029408619
WordScorePoS
height0.120266261535276NN
growth0.0519476926891779NN
age0.112994637345193NN

HAZ

Label: 0, with a score of: 1

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Note HAZ height for age score

Label: 1, with a score of: 0.910347366321829
WordScorePoS
height0.120266261535276NN
age0.112994637345193NN

Label: 3, with a score of: 0.348566846042973
WordScorePoS
height0NN
age0.0893142758861673NN

TABLE D

Label: 0, with a score of: 1

Height for Age Rates in Children under Five Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana Height for Age Malnutrition > standard deviation not stunted to standard deviation mild stunting to standard deviation moderate stunting < standard deviation severe stunting Source Compiled by World Bank team

Label: 1, with a score of: 0.582541264615883
WordScorePoS
height0.120266261535276NN
age0.112994637345193NN
rate0.0639932865717261NN
child0.0450489732120807NN
current0JJ
estimate0NN
infection0NN
malnutrition0.0736315832425121NN
standard0NN
stunt0NN
source0.0269969049497485NN
world0.00257343720272548NN
bank0NN

Label: 2, with a score of: 0.57077203881435
WordScorePoS
height0NN
age0.0365427838531249NN
rate0.0155217067874935NN
child0.0546336178945768NN
current0JJ
estimate0NN
infection0NN
malnutrition0.0357189919948307NN
standard0NN
stunt0.11668334276823NN
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 3, with a score of: 0.432179409144153
WordScorePoS
height0NN
age0.0893142758861673NN
rate0.0433561464459019NN
child0.10682408961305NN
current0JJ
estimate0.059903311017139NN
infection0.122222546933424NN
malnutrition0NN
standard0NN
stunt0NN
source0NN
world0.00087176582269799NN
bank0NN

Prevalence Rates in Prevalence Rates in the Absence of Height Growth Retardation from Diarrheal Infections

Label: 8, with a score of: 0.40657941631702
WordScorePoS
prevalence0NN
rate0NN
height0NN
growth0.208565600657229NN
infection0NN

Label: 1, with a score of: 0.58521326053139
WordScorePoS
prevalence0NN
rate0.0639932865717261NN
height0.120266261535276NN
growth0.0519476926891779NN
infection0NN

Label: 3, with a score of: 0.566140274559473
WordScorePoS
prevalence0.0407408489778079NN
rate0.0433561464459019NN
height0NN
growth0NN
infection0.122222546933424NN

COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE of severely stunted children and more than percent reduction in the number of moderately stunted children

Label: 3, with a score of: 0.720366471280679
WordScorePoS
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
severely0RB
stunt0NN
child0.10682408961305NN
reduction0.0149758277542848NN
moderately0RB

Label: 2, with a score of: 0.444656624611664
WordScorePoS
country0NN
level0.00552410547653725NN
environmental0JJ
health0NN
burden0.0440683498519077NN
disease0NN
severely0RB
stunt0.11668334276823NN
child0.0546336178945768NN
reduction0NN
moderately0RB

The prevalence of mild stunting would be about the same as reported in the DHS

Label: 2, with a score of: 0.816774457417923
WordScorePoS
prevalence0NN
stunt0.11668334276823NN
report0NN

Label: 3, with a score of: 0.500595509701597
WordScorePoS
prevalence0.0407408489778079NN
stunt0NN
report0.0307735781890304NN

Step Assessment of Malnutrition Attributable Loss in School Performance number of recent longitudinal studies see appendix have investigated the effect of early childhood malnutrition on educational outcomes

Label: 4, with a score of: 0.687867341754902
WordScorePoS
malnutrition0NN
loss0NN
school0.208127520578185NN
performance0NN
study0NN
effect0NN
childhood0.0815069365350084NN
educational0JJ
outcome0.0416255041156371NN

These studies use data that follow children over time usually from birth well into primary or secondary schooling containing various anthropometric schooling and socioeconomic status indicators

Label: 3, with a score of: 0.553309524655214
WordScorePoS
study0NN
datum0NN
child0.10682408961305NN
time0.0127591822694525NN
birth0.0748292956291867NN
primary0.0108390366114755JJ
secondary0JJ
schooling0.0407408489778079NN
status0NN

Label: 4, with a score of: 0.47531759921594
WordScorePoS
study0NN
datum0NN
child0.076326555629389NN
time0NN
birth0NN
primary0.108423939529757JJ
secondary0.0615662203253227JJ
schooling0NN
status0NN

Label: 5, with a score of: 0.353068571734011
WordScorePoS
study0NN
datum0NN
child0.0170753354211044NN
time0NN
birth0NN
primary0.0970239057629001JJ
secondary0.0688661930304451JJ
schooling0NN
status0NN

Label: 10, with a score of: 0.33480474812279
WordScorePoS
study0NN
datum0NN
child0.0242343960710022NN
time0.0607862199751165NN
birth0.0396106020715138NN
primary0JJ
secondary0JJ
schooling0NN
status0.0488696285210061NN

The educational and cognitive impacts of malnutrition are expressed as changes in â–  Final grade attainment â–  Learning productivity or school achievements often measured by cognitive and math and reading achievement tests â–  School grade repetition â–  Years of delayed primary school entry The studies reviewed show that the change in grade attainment ranges between

Label: 4, with a score of: 0.708981677927665
WordScorePoS
educational0JJ
impact0NN
malnutrition0NN
final0JJ
learn0.244520809605025VB
productivity0NN
school0.208127520578185NN
achievement0NN
measure0NN
primary0.108423939529757JJ
study0NN
review0NN
change0NN
range0NN

Label: 13, with a score of: 0.410240349993268
WordScorePoS
educational0JJ
impact0.0437569550806737NN
malnutrition0NN
final0JJ
learn0VB
productivity0NN
school0NN
achievement0NN
measure0.0710409787438328NN
primary0.0145856516935579JJ
study0NN
review0NN
change0.402565546215053NN
range0.0335649154577099NN

years mild stunting in the Philippines and

Label: 2, with a score of: 1
WordScorePoS
stunt0.11668334276823NN

years moderate malnutrition in Brazil and

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

Label: 6, with a score of: 0.455176256376397
WordScorePoS
malnutrition0.041835863322702NN

Label: 2, with a score of: 0.388624394633276
WordScorePoS
malnutrition0.0357189919948307NN

years for each score in Zimbabwe

Label: 0, with a score of: 1

The effect of malnutrition on learning productivity or achievement appears to be even larger ranging from

Label: 4, with a score of: 0.62495475082852
WordScorePoS
effect0NN
malnutrition0NN
learn0.244520809605025VB
productivity0NN
achievement0NN
range0NN

Label: 9, with a score of: 0.540375628856866
WordScorePoS
effect0.0454743001434393NN
malnutrition0NN
learn0VB
productivity0.0922368138456871NN
achievement0.0368585655748969NN
range0.0368585655748969NN

Label: 1, with a score of: 0.376380299351732
WordScorePoS
effect0NN
malnutrition0.0736315832425121NN
learn0VB
productivity0NN
achievement0.0736315832425121NN
range0NN

Label: 2, with a score of: 0.356225580484266
WordScorePoS
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
learn0VB
productivity0.0595900566394012NN
achievement0NN
range0NN

years of grade equivalent in Guatemala and the Philippines for each score to

Label: 12, with a score of: 0.73736624946011
WordScorePoS
equivalent0.0664302389559493JJ

years for each score in severely malnourished children in those countries

Label: 3, with a score of: 0.614417683772385
WordScorePoS
severely0RB
child0.10682408961305NN
country0NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
severely0RB
child0.076326555629389NN
country0NN

Label: 16, with a score of: 0.347374750571648
WordScorePoS
severely0RB
child0.0603953832457135NN
country0NN

Label: 2, with a score of: 0.314234936000714
WordScorePoS
severely0RB
child0.0546336178945768NN
country0NN

Delayed primary school entry varies between two to four months per one score in the studies reviewed

Label: 4, with a score of: 0.743753953062679
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
study0NN
review0NN

Label: 5, with a score of: 0.608562659441768
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN
study0NN
review0.0688661930304451NN

The parameters used for Ghana are summarized in table D

Label: 0, with a score of: 1

The magnitude of the effect of child nutritional status on grade attainment applied to Ghana row table D

Label: 2, with a score of: 0.640610658378907
WordScorePoS
effect0.0440683498519077NN
child0.0546336178945768NN
nutritional0.0583416713841148JJ
status0NN

is somewhat lower than that in the study of Zimbabwe about the same as that in the study of Brazil but significantly higher than that in the study in the Philippines

Label: 0, with a score of: 1

The rationale for applying magnitude higher than that found in the Philippines is the substantially higher primary school completion rate there

Label: 4, with a score of: 0.790016860245595
WordScorePoS
substantially0RB
primary0.108423939529757JJ
school0.208127520578185NN
rate0.0216847879059514NN

Label: 5, with a score of: 0.444123319799456
WordScorePoS
substantially0RB
primary0.0970239057629001JJ
school0.0931221694711702NN
rate0NN

Label: 16, with a score of: 0.328606013950073
WordScorePoS
substantially0RB
primary0.0285977592242194JJ
school0.0548954478802642NN
rate0.0571955184484387NN

One important reason for that higher rate is the higher emphasis on school completion in the Philippines which likely reduces losses in grade attainment of children with lower nutritional status

Label: 4, with a score of: 0.603827813676145
WordScorePoS
rate0.0216847879059514NN
school0.208127520578185NN
reduce0VB
loss0NN
child0.076326555629389NN
nutritional0JJ
status0NN

Label: 16, with a score of: 0.383798994091089
WordScorePoS
rate0.0571955184484387NN
school0.0548954478802642NN
reduce0.0220985725470694VB
loss0NN
child0.0603953832457135NN
nutritional0JJ
status0NN

Label: 3, with a score of: 0.329255832057916
WordScorePoS
rate0.0433561464459019NN
school0NN
reduce0.01675146888405VB
loss0NN
child0.10682408961305NN
nutritional0JJ
status0NN

Label: 2, with a score of: 0.327986515231726
WordScorePoS
rate0.0155217067874935NN
school0.0297950283197006NN
reduce0.00799614078871077VB
loss0NN
child0.0546336178945768NN
nutritional0.0583416713841148JJ
status0NN

Primary school competition and years of children school life expectancy in Zimbabwe are also higher than in Ghana

Label: 4, with a score of: 0.807241101869451
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
child0.076326555629389NN
life0.0125233923809486NN
expectancy0NN

Label: 5, with a score of: 0.413603580528012
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN
child0.0170753354211044NN
life0.0140083044329373NN
expectancy0NN

Choosing lower effect on grade attainment in Ghana than that found in Zimbabwe may therefore be considered conservative and possibly an underestimate of actual effect

Label: 0, with a score of: 1

The magnitude of effect of nutritional status on school achievement or learning productivity applied to Ghana row table D

Label: 4, with a score of: 0.827511808257297
WordScorePoS
effect0NN
nutritional0JJ
status0NN
school0.208127520578185NN
achievement0NN
learn0.244520809605025VB
productivity0NN

Label: 2, with a score of: 0.350631394306013
WordScorePoS
effect0.0440683498519077NN
nutritional0.0583416713841148JJ
status0NN
school0.0297950283197006NN
achievement0NN
learn0VB
productivity0.0595900566394012NN

Label: 9, with a score of: 0.319140625448573
WordScorePoS
effect0.0454743001434393NN
nutritional0JJ
status0NN
school0NN
achievement0.0368585655748969NN
learn0VB
productivity0.0922368138456871NN

measured in grade equivalents is about the same as found in Guatemala and the Philippines for children with mild and moderate height for age deficit or stunting

Label: 1, with a score of: 0.67279343238822
WordScorePoS
measure0.103895385378356NN
equivalent0JJ
child0.0450489732120807NN
height0.120266261535276NN
age0.112994637345193NN
stunt0NN

Label: 2, with a score of: 0.517489019371267
WordScorePoS
measure0.0504000902222448NN
equivalent0.0357189919948307JJ
child0.0546336178945768NN
height0NN
age0.0365427838531249NN
stunt0.11668334276823NN

Label: 3, with a score of: 0.34526109091338
WordScorePoS
measure0NN
equivalent0JJ
child0.10682408961305NN
height0NN
age0.0893142758861673NN
stunt0NN

For children with severe ENVIRONMENTAL HEALTH AND CHILD SURVIVAL stunting the magnitude applied is about the midpoint of that found in the Philippines and Guatemala

Label: 3, with a score of: 0.695601716165607
WordScorePoS
child0.10682408961305NN
environmental0JJ
health0.191387734041787NN
stunt0NN

Label: 2, with a score of: 0.388043640241786
WordScorePoS
child0.0546336178945768NN
environmental0JJ
health0NN
stunt0.11668334276823NN

Delayed primary school enrollment is derived from the study in Zimbabwe

Label: 4, with a score of: 0.82048753925159
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
study0NN

Label: 5, with a score of: 0.492850310385397
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN
study0NN

Grade repetition is half of that found by Daniels and Adair in the Philippines

Label: 0, with a score of: 1

The combined effect of delayed enrollment and grade repetition is reported in row table D

Label: 0, with a score of: 1

The cost of delayed enrollment and grade repetition in terms of delayed laborforce participation is however very minimal compared with the cost of lower grade attainment and learning productivity

Label: 4, with a score of: 0.575892410760324
WordScorePoS
cost0NN
term0NN
participation0NN
compare0VB
learn0.244520809605025VB
productivity0NN

Label: 17, with a score of: 0.35279156129026
WordScorePoS
cost0NN
term0.149793392961411NN
participation0NN
compare0VB
learn0VB
productivity0NN

So variations in the magnitude of effects within the range found in studies have minimal influence on the estimated total cost of nutritional status

Label: 12, with a score of: 0.485296863954909
WordScorePoS
effect0NN
range0NN
study0NN
influence0.0542519672965169NN
estimate0.0199423462679015NN
total0.0468670845659596NN
cost0.0277064208763707NN
nutritional0JJ
status0NN

Label: 9, with a score of: 0.425596810203577
WordScorePoS
effect0.0454743001434393NN
range0.0368585655748969NN
study0NN
influence0NN
estimate0.0221298700466866NN
total0.0260040237236563NN
cost0NN
nutritional0JJ
status0NN

Label: 2, with a score of: 0.416277965361164
WordScorePoS
effect0.0440683498519077NN
range0NN
study0NN
influence0NN
estimate0NN
total0.0252000451111224NN
cost0NN
nutritional0.0583416713841148JJ
status0NN

Step Valuation To arrive at costs related to educational and cognitive impacts one has to value the impact of lower grade attainment learning productivity and delay in primary school entry on lifetime income

Label: 4, with a score of: 0.685885762448266
WordScorePoS
cost0NN
related0JJ
educational0JJ
impact0NN
learn0.244520809605025VB
productivity0NN
primary0.108423939529757JJ
school0.208127520578185NN
income0NN

Label: 10, with a score of: 0.284291486672263
WordScorePoS
cost0.0660824365173543NN
related0JJ
educational0JJ
impact0NN
learn0VB
productivity0NN
primary0JJ
school0NN
income0.166475342664294NN

Label: 9, with a score of: 0.318066939506376
WordScorePoS
cost0NN
related0.00925008066007716JJ
educational0JJ
impact0.0160169090870187NN
learn0VB
productivity0.0922368138456871NN
primary0.0160169090870187JJ
school0NN
income0.110649350233433NN

Estimate private marginal returns to schooling that is measure of the increment in returns that one extra year of schooling allows

Label: 16, with a score of: 0.667085150102742
WordScorePoS
estimate0NN
private0JJ
return0.107490825192354NN
schooling0NN
measure0NN

Label: 3, with a score of: 0.438715768364837
WordScorePoS
estimate0.059903311017139NN
private0JJ
return0NN
schooling0.0407408489778079NN
measure0NN

Label: 1, with a score of: 0.322385973993959
WordScorePoS
estimate0NN
private0JJ
return0NN
schooling0NN
measure0.103895385378356NN

This measure helps to estimate the lost returns for one less year of schooling owing to lower educational attainment for example

Label: 15, with a score of: 0.439694196942203
WordScorePoS
measure0.0223459295604043NN
help0NN
estimate0.0190167691930804NN
lose0.0781544824456958VB
return0NN
schooling0NN
educational0JJ

Label: 16, with a score of: 0.395450190402674
WordScorePoS
measure0NN
help0NN
estimate0NN
lose0VB
return0.107490825192354NN
schooling0NN
educational0JJ

Label: 1, with a score of: 0.38222285349757
WordScorePoS
measure0.103895385378356NN
help0NN
estimate0NN
lose0VB
return0NN
schooling0NN
educational0JJ

Label: 3, with a score of: 0.370261854085664
WordScorePoS
measure0NN
help0NN
estimate0.059903311017139NN
lose0VB
return0NN
schooling0.0407408489778079NN
educational0JJ

Label: 2, with a score of: 0.347541872038997
WordScorePoS
measure0.0504000902222448NN
help0NN
estimate0NN
lose0.0440683498519077VB
return0NN
schooling0NN
educational0JJ

Estimate the social cost of providing year of schooling

Label: 10, with a score of: 0.552612705285927
WordScorePoS
estimate0NN
social0.101310366625194JJ
cost0.0660824365173543NN
provide0VB
schooling0NN

Label: 1, with a score of: 0.47064878250559
WordScorePoS
estimate0NN
social0.112994637345193JJ
cost0NN
provide0.0295703421524739VB
schooling0NN

Label: 3, with a score of: 0.365325299574176
WordScorePoS
estimate0.059903311017139NN
social0JJ
cost0NN
provide0.0100171139310145VB
schooling0.0407408489778079NN

Using these estimates calculate the marginal increase in income that schooling allows

Label: 10, with a score of: 0.596218102518752
WordScorePoS
estimate0NN
increase0.00285817158600878NN
income0.166475342664294NN
schooling0NN

Label: 9, with a score of: 0.523697641049781
WordScorePoS
estimate0.0221298700466866NN
increase0.0159575617614215NN
income0.110649350233433NN
schooling0NN

Label: 3, with a score of: 0.405061671387969
WordScorePoS
estimate0.059903311017139NN
increase0.0143984997539974NN
income0NN
schooling0.0407408489778079NN

Estimate the lifetime income in the current situation and in the absence of infections shown in rows and table D

Label: 10, with a score of: 0.492482505105932
WordScorePoS
estimate0NN
income0.166475342664294NN
current0JJ
situation0NN
infection0NN

Label: 3, with a score of: 0.538781283357575
WordScorePoS
estimate0.059903311017139NN
income0NN
current0JJ
situation0NN
infection0.122222546933424NN

Label: 9, with a score of: 0.392799570092678
WordScorePoS
estimate0.0221298700466866NN
income0.110649350233433NN
current0JJ
situation0NN
infection0NN

The present value of lifetime income of child in the current situation is PV ∑ [ ] D

Label: 10, with a score of: 0.517033791166214
WordScorePoS
income0.166475342664294NN
child0.0242343960710022NN
current0JJ
situation0NN

Label: 2, with a score of: 0.390861582900913
WordScorePoS
income0.0643370113878709NN
child0.0546336178945768NN
current0JJ
situation0.0252000451111224NN

Label: 1, with a score of: 0.382821450176501
WordScorePoS
income0.0442083771593746NN
child0.0450489732120807NN
current0JJ
situation0.0519476926891779NN

Label: 4, with a score of: 0.30237634738187
WordScorePoS
income0NN
child0.076326555629389NN
current0JJ
situation0.0352060273355634NN

where is initial annual income of adults at the time the child is one year old is annual rate of growth in real per capita income and is constant annual discount rate

Label: 10, with a score of: 0.617436241551876
WordScorePoS
income0.166475342664294NN
adult0JJ
time0.0607862199751165NN
child0.0242343960710022NN
rate0.0172128079963482NN
growth0.11178243319132NN
capita0NN

Label: 8, with a score of: 0.331660674659598
WordScorePoS
income0NN
adult0JJ
time0NN
child0.0452169560888236NN
rate0NN
growth0.208565600657229NN
capita0.049270765107907NN

Label: 4, with a score of: 0.309397007284491
WordScorePoS
income0NN
adult0.163013873070017JJ
time0NN
child0.076326555629389NN
rate0.0216847879059514NN
growth0NN
capita0NN

Label: 1, with a score of: 0.342984041888603
WordScorePoS
income0.0442083771593746NN
adult0JJ
time0NN
child0.0450489732120807NN
rate0.0639932865717261NN
growth0.0519476926891779NN
capita0NN

It is assumed that an individual has productive working life starting at the age of and ending at the age of see the Ghana DHS

Label: 1, with a score of: 0.597681751553849
WordScorePoS
individual0JJ
productive0JJ
life0.0184786920895884NN
age0.112994637345193NN

Label: 3, with a score of: 0.49793188873384
WordScorePoS
individual0JJ
productive0JJ
life0.0250390290383647NN
age0.0893142758861673NN

Label: 8, with a score of: 0.394383996519181
WordScorePoS
individual0JJ
productive0.0985415302158139JJ
life0.0123650647908625NN
age0.0252035516550537NN

Label: 2, with a score of: 0.353335001947877
WordScorePoS
individual0JJ
productive0.0714379839896614JJ
life0NN
age0.0365427838531249NN

The present value of counterfactual lifetime income of child in the absence of infections is ⎡ PV C PV ⎢ δ ⎢⎣ ∑i ⎤ δ Ej ⎥ ⎥⎦ D

Label: 10, with a score of: 0.51196514999658
WordScorePoS
income0.166475342664294NN
child0.0242343960710022NN
infection0NN

Label: 3, with a score of: 0.614881528407363
WordScorePoS
income0NN
child0.10682408961305NN
infection0.122222546933424NN

where dZ is the counterfactual change in height for age score ij is the percentage change in present value of lifetime income from an additional year of schooling COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE improved learning productivity equivalent to year of schooling and an additional year of labor force participation and dEj is the change in education outcome and labor force participation for

Label: 13, with a score of: 0.644665500020071
WordScorePoS
change0.402565546215053NN
height0NN
age0NN
percentage0NN
income0NN
additional0JJ
schooling0NN
country0NN
level0.0415277415054218NN
environmental0JJ
health0NN
burden0NN
disease0NN
improve0.0102677744436108VB
learn0VB
productivity0NN
equivalent0JJ
force0NN
participation0NN
education0.0102677744436108NN
outcome0NN

Label: 3, with a score of: 0.322125600496248
WordScorePoS
change0NN
height0NN
age0.0893142758861673NN
percentage0NN
income0NN
additional0JJ
schooling0.0407408489778079NN
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
improve0VB
learn0VB
productivity0NN
equivalent0JJ
force0.020806307400253NN
participation0NN
education0.0152605842304358NN
outcome0NN

Label: 4, with a score of: 0.309498319544633
WordScorePoS
change0NN
height0NN
age0.0255262687343935NN
percentage0NN
income0NN
additional0JJ
schooling0NN
country0NN
level0.0231525547935232NN
environmental0JJ
health0NN
burden0NN
disease0NN
improve0.0305306222517556VB
learn0.244520809605025VB
productivity0NN
equivalent0JJ
force0NN
participation0NN
education0.244244978014045NN
outcome0.0416255041156371NN

Label: 10, with a score of: 0.156535779318487
WordScorePoS
change0NN
height0NN
age0.0202620733250388NN
percentage0NN
income0.166475342664294NN
additional0JJ
schooling0NN
country0NN
level0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
burden0NN
disease0NN
improve0.0121171980355011VB
learn0VB
productivity0NN
equivalent0JJ
force0NN
participation0NN
education0.0121171980355011NN
outcome0.0330412182586772NN

Label: 2, with a score of: 0.355650292938517
WordScorePoS
change0.0756001353333673NN
height0NN
age0.0365427838531249NN
percentage0.0583416713841148NN
income0.0643370113878709NN
additional0.0440683498519077JJ
schooling0NN
country0NN
level0.00552410547653725NN
environmental0JJ
health0NN
burden0.0440683498519077NN
disease0NN
improve0.0218534471578307VB
learn0VB
productivity0.0595900566394012NN
equivalent0.0357189919948307JJ
force0.0297950283197006NN
participation0NN
education0NN
outcome0NN

per one score

Label: 0, with a score of: 1

Specifically dZ is the absolute value of percent of the current score of each child

Label: 3, with a score of: 0.583478961374891
WordScorePoS
current0JJ
child0.10682408961305NN

Label: 4, with a score of: 0.416899779490544
WordScorePoS
current0JJ
child0.076326555629389NN

The percentage change in present value of lifetime income from an additional year of schooling and from improved learning productivity equivalent to year of schooling is estimated from table D

Label: 13, with a score of: 0.547712614187238
WordScorePoS
percentage0NN
change0.402565546215053NN
income0NN
additional0JJ
schooling0NN
improve0.0102677744436108VB
learn0VB
productivity0NN
equivalent0JJ
estimate0NN

Label: 4, with a score of: 0.404664815793786
WordScorePoS
percentage0NN
change0NN
income0NN
additional0JJ
schooling0NN
improve0.0305306222517556VB
learn0.244520809605025VB
productivity0NN
equivalent0JJ
estimate0.0299609328954485NN

Label: 10, with a score of: 0.236941599541822
WordScorePoS
percentage0NN
change0NN
income0.166475342664294NN
additional0JJ
schooling0NN
improve0.0121171980355011VB
learn0VB
productivity0NN
equivalent0JJ
estimate0NN

Label: 2, with a score of: 0.476967259918739
WordScorePoS
percentage0.0583416713841148NN
change0.0756001353333673NN
income0.0643370113878709NN
additional0.0440683498519077JJ
schooling0NN
improve0.0218534471578307VB
learn0VB
productivity0.0595900566394012NN
equivalent0.0357189919948307JJ
estimate0NN

For change in lifetime income from an additional year of school that is increased grade attainment the cost of this additional year of schooling is subtracted from income at age

Label: 13, with a score of: 0.502906630730839
WordScorePoS
change0.402565546215053NN
income0NN
additional0JJ
school0NN
increase0.0145316075945746NN
cost0.0279982034978914NN
schooling0NN
age0NN

Label: 10, with a score of: 0.476984816493505
WordScorePoS
change0NN
income0.166475342664294NN
additional0JJ
school0NN
increase0.00285817158600878NN
cost0.0660824365173543NN
schooling0NN
age0.0202620733250388NN

Label: 4, with a score of: 0.28027563484767
WordScorePoS
change0NN
income0NN
additional0JJ
school0.208127520578185NN
increase0.0144029596227568NN
cost0NN
schooling0NN
age0.0255262687343935NN

Label: 2, with a score of: 0.419905427881668
WordScorePoS
change0.0756001353333673NN
income0.0643370113878709NN
additional0.0440683498519077JJ
school0.0297950283197006NN
increase0.0128868286091919NN
cost0NN
schooling0NN
age0.0365427838531249NN

The percentage change in lifetime income from the change in entry into the labor force is estimated on the basis of lifetime income flows

Label: 13, with a score of: 0.757731662553853
WordScorePoS
percentage0NN
change0.402565546215053NN
income0NN
force0NN
estimate0NN
basis0NN
flow0NN

Label: 10, with a score of: 0.359341905846473
WordScorePoS
percentage0NN
change0NN
income0.166475342664294NN
force0NN
estimate0NN
basis0NN
flow0.0488696285210061NN

Label: 2, with a score of: 0.346345563221485
WordScorePoS
percentage0.0583416713841148NN
change0.0756001353333673NN
income0.0643370113878709NN
force0.0297950283197006NN
estimate0NN
basis0NN
flow0NN

Change in educational outcome and labor force participation for one score is as follows see table D

Label: 13, with a score of: 0.839058782757571
WordScorePoS
change0.402565546215053NN
educational0JJ
outcome0NN
force0NN
participation0NN

â– 

Label: 0, with a score of: 1

years of grade attainment row table D

Label: 0, with a score of: 1

â– 

Label: 0, with a score of: 1

years of grade equivalent from learning productivity school achievement for children with mild and moderate stunting row table D

Label: 4, with a score of: 0.776221960306848
WordScorePoS
equivalent0JJ
learn0.244520809605025VB
productivity0NN
school0.208127520578185NN
achievement0NN
child0.076326555629389NN
stunt0NN

Label: 2, with a score of: 0.434970591357278
WordScorePoS
equivalent0.0357189919948307JJ
learn0VB
productivity0.0595900566394012NN
school0.0297950283197006NN
achievement0NN
child0.0546336178945768NN
stunt0.11668334276823NN

TABLE D

Label: 0, with a score of: 1

Parameter Values Applied in Estimation of Income Losses Parameters Average annual income per income earner Ghana Ct

Label: 10, with a score of: 0.795389089287463
WordScorePoS
value0NN
income0.166475342664294NN
loss0NN
average0.146608885563018NN

Label: 13, with a score of: 0.233092239683612
WordScorePoS
value0NN
income0NN
loss0.0236803262479443NN
average0.1656430212089NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Pakistan PRs Remarks Ghana GDP per capita in proxy for per capita income Pakistan income in Household Integrated Economic Survey adjusted to Same as used by WHO for health outcomes Assumed per capita annual real income growth over the next years

Label: 10, with a score of: 0.690962276682967
WordScorePoS
gdp0NN
capita0NN
income0.166475342664294NN
household0.0330412182586772NN
integrate0VB
economic0.103276847978089JJ
survey0.064698038783335NN
health0.0405241466500776NN
outcome0.0330412182586772NN
growth0.11178243319132NN

Label: 8, with a score of: 0.401277407301108
WordScorePoS
gdp0NN
capita0.049270765107907NN
income0NN
household0NN
integrate0.0295821503613099VB
economic0.128463821595706JJ
survey0NN
health0NN
outcome0NN
growth0.208565600657229NN

Label: 3, with a score of: 0.149292399696321
WordScorePoS
gdp0NN
capita0NN
income0NN
household0NN
integrate0VB
economic0JJ
survey0NN
health0.191387734041787NN
outcome0NN
growth0NN

Assumption that cost of year of schooling is of per capita income at time

Label: 10, with a score of: 0.808470811760634
WordScorePoS
cost0.0660824365173543NN
schooling0NN
capita0NN
income0.166475342664294NN
time0.0607862199751165NN

Label: 9, with a score of: 0.356918626345803
WordScorePoS
cost0NN
schooling0NN
capita0NN
income0.110649350233433NN
time0.0188543197850406NN

Calculated from rate of return to year of schooling that is

Label: 16, with a score of: 0.81786296345854
WordScorePoS
rate0.0571955184484387NN
return0.107490825192354NN
schooling0NN

Label: 3, with a score of: 0.417641295414357
WordScorePoS
rate0.0433561464459019NN
return0NN
schooling0.0407408489778079NN

Label: 1, with a score of: 0.317802544157277
WordScorePoS
rate0.0639932865717261NN
return0NN
schooling0NN

in Sub Saharan Africa and

Label: 1, with a score of: 0.57938972469668
WordScorePoS
saharan0.0442083771593746JJ
africa0IN

Label: 5, with a score of: 0.439223058077786
WordScorePoS
saharan0.0335134328085675JJ
africa0IN

Label: 4, with a score of: 0.392664417410503
WordScorePoS
saharan0.0299609328954485JJ
africa0IN

Label: 3, with a score of: 0.392542829083243
WordScorePoS
saharan0.0299516555085695JJ
africa0IN

in Asia see Psacharopoulos and Patrinos less the cost of an additional year of schooling

Label: 10, with a score of: 0.560505188466869
WordScorePoS
asia0IN
cost0.0660824365173543NN
additional0JJ
schooling0NN

Calculated from rate of return to year of schooling that is

Label: 16, with a score of: 0.81786296345854
WordScorePoS
rate0.0571955184484387NN
return0.107490825192354NN
schooling0NN

Label: 3, with a score of: 0.417641295414357
WordScorePoS
rate0.0433561464459019NN
return0NN
schooling0.0407408489778079NN

Label: 1, with a score of: 0.317802544157277
WordScorePoS
rate0.0639932865717261NN
return0NN
schooling0NN

in Sub Saharan Africa and

Label: 1, with a score of: 0.57938972469668
WordScorePoS
saharan0.0442083771593746JJ
africa0IN

Label: 5, with a score of: 0.439223058077786
WordScorePoS
saharan0.0335134328085675JJ
africa0IN

Label: 4, with a score of: 0.392664417410503
WordScorePoS
saharan0.0299609328954485JJ
africa0IN

Label: 3, with a score of: 0.392542829083243
WordScorePoS
saharan0.0299516555085695JJ
africa0IN

in Asia Psacharopoulos and Patrinos ENVIRONMENTAL HEALTH AND CHILD SURVIVAL years of grade equivalent from learning productivity school achievement for children with severe stunting for the first one unit improvement in score row table D

Label: 4, with a score of: 0.624243765085882
WordScorePoS
asia0IN
environmental0JJ
health0NN
child0.076326555629389NN
equivalent0JJ
learn0.244520809605025VB
productivity0NN
school0.208127520578185NN
achievement0NN
stunt0NN
improvement0NN

Label: 3, with a score of: 0.417711120745079
WordScorePoS
asia0IN
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
equivalent0JJ
learn0VB
productivity0NN
school0NN
achievement0NN
stunt0NN
improvement0NN

Label: 2, with a score of: 0.362040571694745
WordScorePoS
asia0IN
environmental0JJ
health0NN
child0.0546336178945768NN
equivalent0.0357189919948307JJ
learn0VB
productivity0.0595900566394012NN
school0.0297950283197006NN
achievement0NN
stunt0.11668334276823NN
improvement0NN

â– 

Label: 0, with a score of: 1

years change in entry into the labor force row table D

Label: 13, with a score of: 0.919599243152757
WordScorePoS
change0.402565546215053NN
force0NN

Additional parameter values are presented in table D

Label: 17, with a score of: 0.782105114075258
WordScorePoS
additional0.036961556179878JJ
value0.036961556179878NN

Label: 2, with a score of: 0.466242298082651
WordScorePoS
additional0.0440683498519077JJ
value0NN

Psacharopoulos and Patrinos reviewed studies of returns to investment in education

Label: 4, with a score of: 0.710684385003147
WordScorePoS
review0NN
study0NN
return0NN
investment0NN
education0.244244978014045NN

Label: 16, with a score of: 0.371346029980999
WordScorePoS
review0NN
study0NN
return0.107490825192354NN
investment0NN
education0.0201317944152378NN

Label: 5, with a score of: 0.34943461885162
WordScorePoS
review0.0688661930304451NN
study0NN
return0NN
investment0NN
education0.0512260062633133NN

Label: 17, with a score of: 0.330502254655736
WordScorePoS
review0.036961556179878NN
study0NN
return0NN
investment0.0766240489430275NN
education0NN

Returns to one additional year of schooling are given by the coefficient on years of schooling

Label: 16, with a score of: 0.733052009900309
WordScorePoS
return0.107490825192354NN
additional0JJ
schooling0NN

On average the return to one additional year of schooling is

Label: 13, with a score of: 0.647448000338197
WordScorePoS
average0.1656430212089NN
return0NN
additional0JJ
schooling0NN

Label: 10, with a score of: 0.573049375076768
WordScorePoS
average0.146608885563018NN
return0NN
additional0JJ
schooling0NN

Label: 16, with a score of: 0.420148819537186
WordScorePoS
average0NN
return0.107490825192354NN
additional0JJ
schooling0NN

percent

Label: 0, with a score of: 1

The return is to percent in Sub Saharan Africa and the group of low income countries

Label: 10, with a score of: 0.598611295695068
WordScorePoS
return0NN
saharan0JJ
africa0IN
income0.166475342664294NN
country0NN

Label: 9, with a score of: 0.477446928903731
WordScorePoS
return0NN
saharan0.0221298700466866JJ
africa0IN
income0.110649350233433NN
country0NN

Label: 16, with a score of: 0.386515030478012
WordScorePoS
return0.107490825192354NN
saharan0JJ
africa0IN
income0NN
country0NN

Label: 1, with a score of: 0.317928571383869
WordScorePoS
return0NN
saharan0.0442083771593746JJ
africa0IN
income0.0442083771593746NN
country0NN

Label: 2, with a score of: 0.308456985334298
WordScorePoS
return0NN
saharan0.0214456704626236JJ
africa0IN
income0.0643370113878709NN
country0NN

This figure is used to estimate the percentage change in the present value of lifetime income from improved educational performance in the absence of early childhood diarrheal infections

Label: 13, with a score of: 0.632950868805091
WordScorePoS
figure0NN
estimate0NN
percentage0NN
change0.402565546215053NN
income0NN
improve0.0102677744436108VB
educational0JJ
performance0NN
childhood0NN
infection0NN

Label: 10, with a score of: 0.37301006471632
WordScorePoS
figure0NN
estimate0NN
percentage0NN
change0NN
income0.166475342664294NN
improve0.0121171980355011VB
educational0JJ
performance0.064698038783335NN
childhood0NN
infection0NN

Label: 2, with a score of: 0.337504027843642
WordScorePoS
figure0NN
estimate0NN
percentage0.0583416713841148NN
change0.0756001353333673NN
income0.0643370113878709NN
improve0.0218534471578307VB
educational0JJ
performance0NN
childhood0NN
infection0NN

Four educational outcomes are considered

Label: 6, with a score of: 0.663486998029278
WordScorePoS
educational0.0683326727248364JJ
outcome0NN

Label: 5, with a score of: 0.452092287690832
WordScorePoS
educational0JJ
outcome0.0465610847355851NN

Label: 4, with a score of: 0.404169479486806
WordScorePoS
educational0JJ
outcome0.0416255041156371NN

Label: 10, with a score of: 0.320818985113572
WordScorePoS
educational0JJ
outcome0.0330412182586772NN

A one year lower grade attainment caused by poor nutritional status stunting results in an additional year of income leaving school early at loss of income in all years of working life lower income per year for each ≥ and saving in cost of year of schooling at

Label: 10, with a score of: 0.599047272906998
WordScorePoS
cause0NN
poor0JJ
nutritional0JJ
status0.0488696285210061NN
stunt0NN
result0NN
additional0JJ
income0.166475342664294NN
leave0NN
school0NN
loss0NN
life0NN
save0IN
cost0.0660824365173543NN
schooling0NN

Label: 1, with a score of: 0.294233319770843
WordScorePoS
cause0NN
poor0.150659516460257JJ
nutritional0JJ
status0NN
stunt0NN
result0NN
additional0JJ
income0.0442083771593746NN
leave0NN
school0NN
loss0NN
life0.0184786920895884NN
save0IN
cost0NN
schooling0NN

Label: 4, with a score of: 0.215144923251498
WordScorePoS
cause0NN
poor0JJ
nutritional0JJ
status0NN
stunt0NN
result0NN
additional0JJ
income0NN
leave0NN
school0.208127520578185NN
loss0NN
life0.0125233923809486NN
save0IN
cost0NN
schooling0NN

Label: 2, with a score of: 0.484318910828869
WordScorePoS
cause0NN
poor0.0548141757796873JJ
nutritional0.0583416713841148JJ
status0NN
stunt0.11668334276823NN
result0NN
additional0.0440683498519077JJ
income0.0643370113878709NN
leave0NN
school0.0297950283197006NN
loss0NN
life0NN
save0IN
cost0NN
schooling0NN

Ct for ≠

Label: 0, with a score of: 1

Lower learning productivity equivalent to one year of schooling results in loss of income in all years of working life for each ≥

Label: 4, with a score of: 0.545929580111317
WordScorePoS
learn0.244520809605025VB
productivity0NN
equivalent0JJ
schooling0NN
result0NN
loss0NN
income0NN
life0.0125233923809486NN

Label: 10, with a score of: 0.353572705462405
WordScorePoS
learn0VB
productivity0NN
equivalent0JJ
schooling0NN
result0NN
loss0NN
income0.166475342664294NN
life0NN

Label: 9, with a score of: 0.430904714093314
WordScorePoS
learn0VB
productivity0.0922368138456871NN
equivalent0JJ
schooling0NN
result0NN
loss0NN
income0.110649350233433NN
life0NN

Label: 2, with a score of: 0.339068167423783
WordScorePoS
learn0VB
productivity0.0595900566394012NN
equivalent0.0357189919948307JJ
schooling0NN
result0NN
loss0NN
income0.0643370113878709NN
life0NN

Ct for all years

Label: 0, with a score of: 1

Delayed primary school enrollment results in delayed labor force entry

Label: 4, with a score of: 0.752675864603748
WordScorePoS
primary0.108423939529757JJ
school0.208127520578185NN
result0NN
force0NN

Label: 5, with a score of: 0.562827182118525
WordScorePoS
primary0.0970239057629001JJ
school0.0931221694711702NN
result0NN
force0.0465610847355851NN

A oneyear delay results in lost income at

Label: 10, with a score of: 0.644164504856586
WordScorePoS
result0NN
lose0VB
income0.166475342664294NN

Label: 9, with a score of: 0.428149795429795
WordScorePoS
result0NN
lose0VB
income0.110649350233433NN

Label: 2, with a score of: 0.419466839528536
WordScorePoS
result0NN
lose0.0440683498519077VB
income0.0643370113878709NN

Label: 15, with a score of: 0.302413214360978
WordScorePoS
result0NN
lose0.0781544824456958VB
income0NN

Ct for all years

Label: 0, with a score of: 1

Grade repetition has the same effect as delayed enrollment

Label: 0, with a score of: 1

The cost of these educational outcomes is implicit in the difference between current and counterfactual lifetime incomes in rows and table D

Label: 10, with a score of: 0.769535314910297
WordScorePoS
cost0.0660824365173543NN
educational0JJ
outcome0.0330412182586772NN
current0JJ
income0.166475342664294NN

Label: 9, with a score of: 0.409671768925406
WordScorePoS
cost0NN
educational0JJ
outcome0.030745604615229NN
current0JJ
income0.110649350233433NN

In fact counterfactual lifetime income in each malnutrition category rises as consequence of reducing infections and subsequent higher educational outcomes

Label: 10, with a score of: 0.579669099382434
WordScorePoS
income0.166475342664294NN
malnutrition0NN
rise0.0237821918091848NN
reduce0.0310356414389692VB
infection0NN
educational0JJ
outcome0.0330412182586772NN

Label: 9, with a score of: 0.372699446658319
WordScorePoS
income0.110649350233433NN
malnutrition0NN
rise0.0221298700466866NN
reduce0VB
infection0NN
educational0JJ
outcome0.030745604615229NN

Label: 6, with a score of: 0.329685810668834
WordScorePoS
income0NN
malnutrition0.041835863322702NN
rise0.0251182378961834NN
reduce0.00936547854413134VB
infection0NN
educational0.0683326727248364JJ
outcome0NN

Label: 3, with a score of: 0.316744193599991
WordScorePoS
income0NN
malnutrition0NN
rise0NN
reduce0.01675146888405VB
infection0.122222546933424NN
educational0JJ
outcome0NN

Label: 1, with a score of: 0.306144476993848
WordScorePoS
income0.0442083771593746NN
malnutrition0.0736315832425121NN
rise0NN
reduce0.0164833460638534VB
infection0NN
educational0JJ
outcome0NN

In estimations of current and counterfactual lifetime income for children of different nutritional status from not malnourished to severely malnourished assumptions about baseline income in equation D

Label: 10, with a score of: 0.705359135256064
WordScorePoS
current0JJ
income0.166475342664294NN
child0.0242343960710022NN
nutritional0JJ
status0.0488696285210061NN
severely0RB

Label: 2, with a score of: 0.419769911840868
WordScorePoS
current0JJ
income0.0643370113878709NN
child0.0546336178945768NN
nutritional0.0583416713841148JJ
status0NN
severely0RB

Malnourished children live in disproportionately poorer households and poverty is correlated with lower socioeconomic status such as lower educational attainment of parents

Label: 1, with a score of: 0.731529977267772
WordScorePoS
child0.0450489732120807NN
live0.0739258553811849VB
household0NN
poverty0.269969049497485NN
status0NN
educational0JJ

Label: 10, with a score of: 0.33881960118923
WordScorePoS
child0.0242343960710022NN
live0.0159075630937118VB
household0.0330412182586772NN
poverty0.05809266143877NN
status0.0488696285210061NN
educational0JJ

This factor in turn is correlated with lower educational attainment of children as they grow up

Label: 3, with a score of: 0.486674401708203
WordScorePoS
educational0JJ
child0.10682408961305NN
grow0VB

Label: 6, with a score of: 0.427924131684758
WordScorePoS
educational0.0683326727248364JJ
child0.0255958462813622NN
grow0VB

Label: 4, with a score of: 0.347732247753626
WordScorePoS
educational0JJ
child0.076326555629389NN
grow0VB

Label: 2, with a score of: 0.332144202349458
WordScorePoS
educational0JJ
child0.0546336178945768NN
grow0.0182713919265625VB

Malnourished children are therefore likely to have lower income than children who are not malnourished not only because of the effect of malnutrition on educational performance and income but also because of the socioeconomic status of the household they grew up in

Label: 10, with a score of: 0.654550829839498
WordScorePoS
child0.0242343960710022NN
income0.166475342664294NN
effect0NN
malnutrition0NN
educational0JJ
performance0.064698038783335NN
status0.0488696285210061NN
household0.0330412182586772NN
grow0.0405241466500776VB

Label: 2, with a score of: 0.421124575557655
WordScorePoS
child0.0546336178945768NN
income0.0643370113878709NN
effect0.0440683498519077NN
malnutrition0.0357189919948307NN
educational0JJ
performance0NN
status0NN
household0.0297950283197006NN
grow0.0182713919265625VB

Label: 9, with a score of: 0.328830840433048
WordScorePoS
child0NN
income0.110649350233433NN
effect0.0454743001434393NN
malnutrition0NN
educational0JJ
performance0NN
status0NN
household0NN
grow0.0188543197850406VB

Therefore instead of using GDP per capita as proxy for per capita income for all children this analysis attempts to develop matrix of income differentials in Ghana across the range of nutritional status from not malnourished to severely malnourished

Label: 10, with a score of: 0.686125061906718
WordScorePoS
gdp0NN
capita0NN
income0.166475342664294NN
child0.0242343960710022NN
develop0VB
differential0.0488696285210061JJ
range0NN
nutritional0JJ
status0.0488696285210061NN
severely0RB

These figures represent more accurate estimate of lifetime income of children as they move across nutritional categories

Label: 10, with a score of: 0.453923348935056
WordScorePoS
figure0NN
represent0VB
estimate0NN
income0.166475342664294NN
child0.0242343960710022NN
move0NN
nutritional0JJ

Label: 9, with a score of: 0.459332251885272
WordScorePoS
figure0.0602029956716497NN
represent0VB
estimate0.0221298700466866NN
income0.110649350233433NN
child0NN
move0NN
nutritional0JJ

Label: 2, with a score of: 0.422035045822489
WordScorePoS
figure0NN
represent0VB
estimate0NN
income0.0643370113878709NN
child0.0546336178945768NN
move0NN
nutritional0.0583416713841148JJ

Label: 3, with a score of: 0.396841087168273
WordScorePoS
figure0NN
represent0VB
estimate0.059903311017139NN
income0NN
child0.10682408961305NN
move0NN
nutritional0JJ

Table D

Label: 0, with a score of: 1

panel shows the distribution of children by nutritional status and household wealth in Ghana

Label: 2, with a score of: 0.541533324565915
WordScorePoS
panel0NN
child0.0546336178945768NN
nutritional0.0583416713841148JJ
status0NN
household0.0297950283197006NN

Label: 3, with a score of: 0.405187894549685
WordScorePoS
panel0NN
child0.10682408961305NN
nutritional0JJ
status0NN
household0NN

Label: 10, with a score of: 0.402613002581395
WordScorePoS
panel0NN
child0.0242343960710022NN
nutritional0JJ
status0.0488696285210061NN
household0.0330412182586772NN

â–  COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE TABLE D

Label: 3, with a score of: 0.859914684372597
WordScorePoS
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN

Income Distribution across Malnutrition Categories and Wealth Quintiles in Ghana Wealth Quintile Not Malnourished Height forAge > − Mild Height forAge − to − Standard Deviation Moderate Height forAge − to − Standard Deviation a

Label: 10, with a score of: 0.481168965529986
WordScorePoS
income0.166475342664294NN
malnutrition0NN
quintile0.064698038783335NN
height0NN
standard0NN

Height for age prevalence rates Ghana DHS Poorest

Label: 1, with a score of: 0.795220587119119
WordScorePoS
height0.120266261535276NN
age0.112994637345193NN
prevalence0NN
rate0.0639932865717261NN
poorest0JJS

Label: 3, with a score of: 0.463913444227317
WordScorePoS
height0NN
age0.0893142758861673NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
poorest0JJS

Poorer

Label: 0, with a score of: 1

Middle

Label: 9, with a score of: 1
WordScorePoS
middle0.0602029956716497JJ

Richer

Label: 0, with a score of: 1

Richest

Label: 10, with a score of: 1
WordScorePoS
richest0.064698038783335JJS

Total

Label: 7, with a score of: 0.62423395560285
WordScorePoS
total0.0528748274225028NN

Label: 12, with a score of: 0.553307254365265
WordScorePoS
total0.0468670845659596NN

Label: 6, with a score of: 0.348457073659399
WordScorePoS
total0.0295155485671997NN

Label: 9, with a score of: 0.307000426893118
WordScorePoS
total0.0260040237236563NN

Per capita income expenditure shares Poorest

Label: 10, with a score of: 0.710008270342563
WordScorePoS
capita0NN
income0.166475342664294NN
expenditure0.064698038783335NN
share0NN
poorest0.0330412182586772JJS

Label: 9, with a score of: 0.398673653344595
WordScorePoS
capita0NN
income0.110649350233433NN
expenditure0NN
share0.0377086395700813NN
poorest0JJS

Label: 2, with a score of: 0.351154726335266
WordScorePoS
capita0NN
income0.0643370113878709NN
expenditure0NN
share0.0365427838531249NN
poorest0.0297950283197006JJS

Poorer

Label: 0, with a score of: 1

Middle

Label: 9, with a score of: 1
WordScorePoS
middle0.0602029956716497JJ

Richer

Label: 0, with a score of: 1

Richest

Label: 10, with a score of: 1
WordScorePoS
richest0.064698038783335JJS

Total

Label: 7, with a score of: 0.62423395560285
WordScorePoS
total0.0528748274225028NN

Label: 12, with a score of: 0.553307254365265
WordScorePoS
total0.0468670845659596NN

Label: 6, with a score of: 0.348457073659399
WordScorePoS
total0.0295155485671997NN

Label: 9, with a score of: 0.307000426893118
WordScorePoS
total0.0260040237236563NN

Per household income expenditure shares Poorest

Label: 10, with a score of: 0.730501294942844
WordScorePoS
household0.0330412182586772NN
income0.166475342664294NN
expenditure0.064698038783335NN
share0NN
poorest0.0330412182586772JJS

Label: 2, with a score of: 0.394352027827174
WordScorePoS
household0.0297950283197006NN
income0.0643370113878709NN
expenditure0NN
share0.0365427838531249NN
poorest0.0297950283197006JJS

Label: 9, with a score of: 0.364587325518222
WordScorePoS
household0NN
income0.110649350233433NN
expenditure0NN
share0.0377086395700813NN
poorest0JJS

Poorer

Label: 0, with a score of: 1

Middle

Label: 9, with a score of: 1
WordScorePoS
middle0.0602029956716497JJ

Richer

Label: 0, with a score of: 1

Richest

Label: 10, with a score of: 1
WordScorePoS
richest0.064698038783335JJS

Total

Label: 7, with a score of: 0.62423395560285
WordScorePoS
total0.0528748274225028NN

Label: 12, with a score of: 0.553307254365265
WordScorePoS
total0.0468670845659596NN

Label: 6, with a score of: 0.348457073659399
WordScorePoS
total0.0295155485671997NN

Label: 9, with a score of: 0.307000426893118
WordScorePoS
total0.0260040237236563NN

Severe Height forAge < − Standard Deviation

Label: 1, with a score of: 0.891199158734391
WordScorePoS
height0.120266261535276NN
standard0NN

Total Total

Label: 7, with a score of: 0.62423395560285
WordScorePoS
total0.0528748274225028NN

Label: 12, with a score of: 0.553307254365265
WordScorePoS
total0.0468670845659596NN

Label: 6, with a score of: 0.348457073659399
WordScorePoS
total0.0295155485671997NN

Label: 9, with a score of: 0.307000426893118
WordScorePoS
total0.0260040237236563NN

Total

Label: 7, with a score of: 0.62423395560285
WordScorePoS
total0.0528748274225028NN

Label: 12, with a score of: 0.553307254365265
WordScorePoS
total0.0468670845659596NN

Label: 6, with a score of: 0.348457073659399
WordScorePoS
total0.0295155485671997NN

Label: 9, with a score of: 0.307000426893118
WordScorePoS
total0.0260040237236563NN

Source Compiled by World Bank team

Label: 2, with a score of: 0.737559496131694
WordScorePoS
source0.0130963126055467NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 6, with a score of: 0.426402661922482
WordScorePoS
source0.0613562156822703NN
world0.00438651305628668NN
bank0NN

Label: 17, with a score of: 0.33813808928791
WordScorePoS
source0.0109843026967392NN
world0.00418824502414673NN
bank0.036961556179878NN

Estimated from the height for age prevalence rates and total income expenditure shares

Label: 10, with a score of: 0.438806285893558
WordScorePoS
estimate0NN
height0NN
age0.0202620733250388NN
prevalence0NN
rate0.0172128079963482NN
total0NN
income0.166475342664294NN
expenditure0.064698038783335NN
share0NN

Label: 1, with a score of: 0.557740136961572
WordScorePoS
estimate0NN
height0.120266261535276NN
age0.112994637345193NN
prevalence0NN
rate0.0639932865717261NN
total0NN
income0.0442083771593746NN
expenditure0NN
share0NN

Label: 3, with a score of: 0.381092750276785
WordScorePoS
estimate0.059903311017139NN
height0NN
age0.0893142758861673NN
prevalence0.0407408489778079NN
rate0.0433561464459019NN
total0NN
income0NN
expenditure0NN
share0NN

Label: 9, with a score of: 0.320947073137813
WordScorePoS
estimate0.0221298700466866NN
height0NN
age0NN
prevalence0NN
rate0NN
total0.0260040237236563NN
income0.110649350233433NN
expenditure0NN
share0.0377086395700813NN

Total income expenditure shares by quintile in Ghana in from the Ghana Living Standard Survey World Bank Trades Union Congress

Label: 10, with a score of: 0.65090644327424
WordScorePoS
total0NN
income0.166475342664294NN
expenditure0.064698038783335NN
share0NN
quintile0.064698038783335NN
live0.0159075630937118VB
standard0NN
survey0.064698038783335NN
world0.00276879546803864NN
bank0NN
trade0.0237821918091848NN

Label: 2, with a score of: 0.423933135196689
WordScorePoS
total0.0252000451111224NN
income0.0643370113878709NN
expenditure0NN
share0.0365427838531249NN
quintile0NN
live0.0143446978608332VB
standard0NN
survey0NN
world0.0124838525528648NN
bank0.0881366997038154NN
trade0.0214456704626236NN

Label: 9, with a score of: 0.371158715384048
WordScorePoS
total0.0260040237236563NN
income0.110649350233433NN
expenditure0NN
share0.0377086395700813NN
quintile0NN
live0.00740117451847634VB
standard0.0454743001434393NN
survey0NN
world0.00257642711761688NN
bank0NN
trade0NN

Label: 17, with a score of: 0.306409582480228
WordScorePoS
total0NN
income0.017987180284335NN
expenditure0NN
share0.0766240489430275NN
quintile0NN
live0VB
standard0NN
survey0NN
world0.00418824502414673NN
bank0.036961556179878NN
trade0.0539615408530051NN

Panels and show the income expenditure shares in relation to household wealth quintile and children nutritional status

Label: 10, with a score of: 0.763662585813904
WordScorePoS
panel0NN
income0.166475342664294NN
expenditure0.064698038783335NN
share0NN
relation0.064698038783335NN
household0.0330412182586772NN
quintile0.064698038783335NN
child0.0242343960710022NN
nutritional0JJ
status0.0488696285210061NN

Label: 2, with a score of: 0.398672839019765
WordScorePoS
panel0NN
income0.0643370113878709NN
expenditure0NN
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household0.0297950283197006NN
quintile0NN
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nutritional0.0583416713841148JJ
status0NN

Total income expenditure shares for each group of children not malnourished and mild moderate and severely malnourished are then used to estimate baseline annual income for each of these four groups which is applied in equations D

Label: 10, with a score of: 0.625196667104619
WordScorePoS
total0NN
income0.166475342664294NN
expenditure0.064698038783335NN
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severely0RB
estimate0NN

Label: 9, with a score of: 0.455158470486941
WordScorePoS
total0.0260040237236563NN
income0.110649350233433NN
expenditure0NN
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child0NN
severely0RB
estimate0.0221298700466866NN

Label: 2, with a score of: 0.363144979162769
WordScorePoS
total0.0252000451111224NN
income0.0643370113878709NN
expenditure0NN
share0.0365427838531249NN
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severely0RB
estimate0NN

to estimate lifetime income rows and table D

Label: 10, with a score of: 0.682975582212594
WordScorePoS
estimate0NN
income0.166475342664294NN

Label: 9, with a score of: 0.544735117076287
WordScorePoS
estimate0.0221298700466866NN
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By combining the information on current stunting prevalence row table D

Label: 2, with a score of: 0.707074612157071
WordScorePoS
information0.0130963126055467NN
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stunt0.11668334276823NN
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lifetime income rows and and labor force participation row one can obtain total current and counterfactual lifetime income per malnutrition category rows and and for the whole population birth cohort rows and

Label: 10, with a score of: 0.65580758096477
WordScorePoS
income0.166475342664294NN
force0NN
participation0NN
obtain0VB
total0NN
current0JJ
malnutrition0NN
population0.0860640399817412NN
birth0.0396106020715138NN

The difference between current and counterfactual lifetime income for an annual population birth cohort as whole represents the educational and cognitive TABLE D

Label: 10, with a score of: 0.737232015804213
WordScorePoS
current0JJ
income0.166475342664294NN
population0.0860640399817412NN
birth0.0396106020715138NN
represent0VB
educational0JJ

Label: 6, with a score of: 0.394436972145413
WordScorePoS
current0JJ
income0NN
population0.0363595928905615NN
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represent0.0516150472983178VB
educational0.0683326727248364JJ

Annual Cost of Environmental Factors Percentage of GDP in Using Percent Discount Rate Annual Deaths Cost million Ghana Cost US million Estimates excluding malnutrition mediated effects Mortality effects Estimates including malnutrition mediated effects Mortality effects Education effects Total annual costs Source Compiled by World Bank team

Label: 3, with a score of: 0.663795230348383
WordScorePoS
cost0NN
environmental0JJ
percentage0NN
gdp0NN
rate0.0433561464459019NN
death0.193573191943949NN
estimate0.059903311017139NN
malnutrition0NN
effect0NN
mortality0.276962203701274NN
include0VB
education0.0152605842304358NN
total0NN
source0NN
world0.00087176582269799NN
bank0NN

Label: 4, with a score of: 0.234633334087651
WordScorePoS
cost0NN
environmental0JJ
percentage0NN
gdp0NN
rate0.0216847879059514NN
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education0.244244978014045NN
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Note Ghanaian new cedi

Label: 0, with a score of: 1

Cost of GDP in Annual Deaths Pakistan Cost Cost PRs billion US million Cost of GDP

Label: 3, with a score of: 0.415780072192652
WordScorePoS
cost0NN
gdp0NN
death0.193573191943949NN

Label: 16, with a score of: 0.571371406563819
WordScorePoS
cost0.0548954478802642NN
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TABLE D

Label: 0, with a score of: 1

Annual Cost of Environmental Factors Percentage of GDP in Using Percent Discount Rate Annual Deaths Cost million Estimates excluding malnutrition mediated effects Mortality effects Estimates including malnutrition mediated effects Mortality effects Education effects Total annual cost Source Compiled by World Bank team

Label: 3, with a score of: 0.682765100761025
WordScorePoS
cost0NN
environmental0JJ
percentage0NN
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rate0.0433561464459019NN
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Label: 4, with a score of: 0.241338660879157
WordScorePoS
cost0NN
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Note Ghanaian new cedi

Label: 0, with a score of: 1

Ghana Cost US million Cost of GDP in

Label: 10, with a score of: 0.673069204027553
WordScorePoS
cost0.0660824365173543NN
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Label: 16, with a score of: 0.559126408721358
WordScorePoS
cost0.0548954478802642NN
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Annual Deaths Pakistan Cost Cost PRs billion US million Cost of GDP ENVIRONMENTAL HEALTH AND CHILD SURVIVAL cost of malnutrition from diarrheal infections

Label: 3, with a score of: 0.706384028829273
WordScorePoS
death0.193573191943949NN
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infection0.122222546933424NN

Label: 16, with a score of: 0.375514023067503
WordScorePoS
death0.0464294830712827NN
cost0.0548954478802642NN
gdp0NN
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This cost is estimated at

Label: 10, with a score of: 0.519922740256742
WordScorePoS
cost0.0660824365173543NN
estimate0NN

Label: 3, with a score of: 0.471306677778195
WordScorePoS
cost0NN
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Label: 16, with a score of: 0.43190586173427
WordScorePoS
cost0.0548954478802642NN
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Label: 12, with a score of: 0.374890498733342
WordScorePoS
cost0.0277064208763707NN
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percent of GDP in

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

The cost attributable to environmental factors that is diarrheal infections from inadequate water supply sanitation and hygiene is about onethird of the total cost of stunting on lifetime income

Label: 6, with a score of: 0.854938393240522
WordScorePoS
cost0NN
environmental0JJ
infection0NN
inadequate0.0836717266454039JJ
water0.556409482163189NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
total0.0295155485671997NN
stunt0NN
income0NN

Label: 12, with a score of: 0.298737522257697
WordScorePoS
cost0.0277064208763707NN
environmental0.0598270388037045JJ
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inadequate0JJ
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total0.0468670845659596NN
stunt0NN
income0NN

Label: 10, with a score of: 0.229713220675181
WordScorePoS
cost0.0660824365173543NN
environmental0.0237821918091848JJ
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income0.166475342664294NN

Summary of Results for Ghana and Pakistan The methodology described in this appendix has also been applied to Pakistan

Label: 0, with a score of: 1

The results summarized in chapter are reported here for convenience table D

Label: 6, with a score of: 0.800011198546063
WordScorePoS
result0.0683326727248364NN
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In total the cost of malnutrition mediated effects mortality and education effects of environmental risk factors on children in Ghana and Pakistan is estimated at an equivalent of

Label: 3, with a score of: 0.621190604006897
WordScorePoS
total0NN
cost0NN
malnutrition0NN
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mortality0.276962203701274NN
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Label: 4, with a score of: 0.411356204978678
WordScorePoS
total0NN
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Label: 2, with a score of: 0.310522745397455
WordScorePoS
total0.0252000451111224NN
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percent and

Label: 0, with a score of: 1

percent respectively of GDP per year

Label: 14, with a score of: 1
WordScorePoS
gdp0.0531983120572613NN

This finding is in stark contrast to cost of

Label: 10, with a score of: 0.699218736404889
WordScorePoS
cost0.0660824365173543NN

Label: 16, with a score of: 0.580849129119786
WordScorePoS
cost0.0548954478802642NN

percent and

Label: 0, with a score of: 1

percent arrived at when considering only the estimates excluding malnutrition mediated effects of environmental risks

Label: 1, with a score of: 0.562526314620437
WordScorePoS
estimate0NN
malnutrition0.0736315832425121NN
effect0NN
environmental0.0442083771593746JJ
risk0.0519476926891779NN

Label: 3, with a score of: 0.431677782644571
WordScorePoS
estimate0.059903311017139NN
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effect0NN
environmental0JJ
risk0.0703902516159815NN

Label: 11, with a score of: 0.38747717761214
WordScorePoS
estimate0NN
malnutrition0NN
effect0NN
environmental0.0537696560159885JJ
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Label: 2, with a score of: 0.347835468550588
WordScorePoS
estimate0NN
malnutrition0.0357189919948307NN
effect0.0440683498519077NN
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The annualized monetary cost of mortality and impaired education is sensitive to the discount rate of income losses

Label: 3, with a score of: 0.508572175067835
WordScorePoS
cost0NN
mortality0.276962203701274NN
education0.0152605842304358NN
sensitive0JJ
rate0.0433561464459019NN
income0NN
loss0NN

Label: 4, with a score of: 0.496322411773769
WordScorePoS
cost0NN
mortality0NN
education0.244244978014045NN
sensitive0.0615662203253227JJ
rate0.0216847879059514NN
income0NN
loss0NN

Label: 10, with a score of: 0.47095499040942
WordScorePoS
cost0.0660824365173543NN
mortality0.0488696285210061NN
education0.0121171980355011NN
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Label: 1, with a score of: 0.33578964998294
WordScorePoS
cost0NN
mortality0NN
education0.0225244866060403NN
sensitive0.0908430554521382JJ
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income0.0442083771593746NN
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Annual costs are presented in tables D

Label: 10, with a score of: 0.699218736404889
WordScorePoS
cost0.0660824365173543NN

Label: 16, with a score of: 0.580849129119786
WordScorePoS
cost0.0548954478802642NN

using discount rates of and percent

Label: 1, with a score of: 0.596643111610239
WordScorePoS
rate0.0639932865717261NN

Label: 16, with a score of: 0.533263939475719
WordScorePoS
rate0.0571955184484387NN

Label: 3, with a score of: 0.404232186042173
WordScorePoS
rate0.0433561464459019NN

Label: 7, with a score of: 0.303645839941113
WordScorePoS
rate0.0325677023224526NN

In both Ghana and Pakistan at an annual discount rate of percent the annual cost is half of the cost at percent discount rate

Label: 0, with a score of: 1

Total costs in Ghana and Pakistan are however nearly two and one half and nearly three times higher respectively than the cost that does not include malnutrition effects regardless of the discount rate used

Label: 10, with a score of: 0.537362784257108
WordScorePoS
total0NN
cost0.0660824365173543NN
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rate0.0172128079963482NN

Label: 16, with a score of: 0.426963355946678
WordScorePoS
total0NN
cost0.0548954478802642NN
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malnutrition0NN
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rate0.0571955184484387NN

Label: 2, with a score of: 0.354844327804061
WordScorePoS
total0.0252000451111224NN
cost0NN
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rate0.0155217067874935NN

Label: 1, with a score of: 0.351889562728609
WordScorePoS
total0NN
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Notes This appendix is based on the analysis of country specific data and surveys for Ghana

Label: 17, with a score of: 0.567954474070878
WordScorePoS
base0.017987180284335NN
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Results are arrived at using methodology developed specifically for this report by Björn Larsen consultant

Label: 0, with a score of: 1

Useful input was provided by Maureen Cropper

Label: 2, with a score of: 1
WordScorePoS
input0.0583416713841148NN

The analysis estimates costs that are attributable to environmental risks in children under five years of age for Ghana and Pakistan and for the first time includes the malnutrition mediated effects as well as the longer term impacts on cognition school performance and future work productivity

Label: 4, with a score of: 0.370975796475384
WordScorePoS
estimate0.0299609328954485NN
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term0NN
impact0NN
school0.208127520578185NN
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future0NN
productivity0NN

Label: 17, with a score of: 0.1801924649088
WordScorePoS
estimate0NN
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Label: 3, with a score of: 0.370157143431272
WordScorePoS
estimate0.059903311017139NN
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Label: 2, with a score of: 0.364072289668123
WordScorePoS
estimate0NN
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Label: 1, with a score of: 0.357760213514405
WordScorePoS
estimate0NN
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Label: 10, with a score of: 0.326794420024689
WordScorePoS
estimate0NN
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See appendix for more detail on impact fractions or attributable fractions

Label: 12, with a score of: 0.7540481934975
WordScorePoS
impact0.0866018859977851NN

The use of the Cox hazard model has drawback if one wants to calculate the attributable fractions of individual risks as opposed to calculating joint attributable fractions as is done here

Label: 0, with a score of: 1

In fact in such model specifications the effect of each risk factor is augmented by the multiplicative interaction with other risk factors

Label: 0, with a score of: 1

The result is that the fractions attributable to individual risks may add to more than

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WordScorePoS
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add0.0804764811724088VB

Label: 3, with a score of: 0.419827471743394
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Label: 6, with a score of: 0.407555486291563
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Label: 10, with a score of: 0.385877496181541
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Label: 11, with a score of: 0.376840250704101
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If one imposes additive relative risks so that the sum of the attributable fraction equals the results do not differ much from those presented here

Label: 11, with a score of: 0.564282828175593
WordScorePoS
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Label: 5, with a score of: 0.472763291493118
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The estimate of the impact of single risk factor on disease for example the impact of malnutrition on deaths caused by ALRI is often biased because other risk factors were not controlled for in the epidemiological study

Label: 3, with a score of: 0.749727965515383
WordScorePoS
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So if the relative risk of ALRI death attributable to malnutrition is estimated ignoring indoor air pollution MAL will pick up its effects because malnutrition and exposure to indoor air pollution are correlated in most populations

Label: 3, with a score of: 0.525646069667564
WordScorePoS
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Label: 11, with a score of: 0.426706402589779
WordScorePoS
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Label: 1, with a score of: 0.419122991025101
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Appendix describes method to deal with biased relative risks

Label: 11, with a score of: 0.823979964851217
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Label: 3, with a score of: 0.425466304459037
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COMPUTING COUNTRY LEVEL ENVIRONMENTAL HEALTH BURDEN OF DISEASE This framework for calculating relative risks can be expanded to larger set of exposure categories that reflect different risk levels associated with ENV and MAL

Label: 3, with a score of: 0.666009525271889
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Label: 11, with a score of: 0.401179405306218
WordScorePoS
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Label: 1, with a score of: 0.385398950753865
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For instance indoor air pollution exposure categories can be households using fuelwood charcoal unimproved rather than improved stoves and liquefied petroleum gas

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WordScorePoS
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Label: 12, with a score of: 0.448310469053257
WordScorePoS
air0.0554128417527413NN
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Malnutrition can be mild moderate and severe

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WordScorePoS
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Label: 6, with a score of: 0.455176256376397
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For the alternative approaches please see appendix E

Label: 9, with a score of: 0.742868974909555
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Label: 12, with a score of: 0.66943684251528
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Although the research literature finds that the retardation factor often is in the range of

Label: 9, with a score of: 0.861481297739873
WordScorePoS
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Label: 7, with a score of: 0.323341861438341
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there is limited research on how the retardation factor may vary with score and age

Label: 1, with a score of: 0.796672618887921
WordScorePoS
limited0.120266261535276JJ
research0NN
age0.112994637345193NN

Label: 3, with a score of: 0.365143643910625
WordScorePoS
limited0JJ
research0.0175975629039954NN
age0.0893142758861673NN

Label: 9, with a score of: 0.355253602828048
WordScorePoS
limited0JJ
research0.104016094894625NN
age0NN

It is postulated here that the factor declines with age and is greater the more underweight the children are

Label: 3, with a score of: 0.676872273046028
WordScorePoS
decline0.0351951258079907NN
age0.0893142758861673NN
child0.10682408961305NN

Label: 1, with a score of: 0.462429098846914
WordScorePoS
decline0NN
age0.112994637345193NN
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Diarrheal infections are most frequent during the ages of to months and to months

Label: 3, with a score of: 0.85801364049514
WordScorePoS
infection0.122222546933424NN
age0.0893142758861673NN

Label: 1, with a score of: 0.458317085662488
WordScorePoS
infection0NN
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It may therefore be expected that weight gain retardation from diarrheal infections is greatest in this period and at least in Ghana and Pakistan is particularly great up to the age of months during which underweight increases rapidly

Label: 3, with a score of: 0.667858984738946
WordScorePoS
expect0VB
gain0NN
infection0.122222546933424NN
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age0.0893142758861673NN
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rapidly0RB

Label: 12, with a score of: 0.44402081737326
WordScorePoS
expect0.0332151194779746VB
gain0.0664302389559493NN
infection0NN
period0.0409791940864438NN
age0NN
increase0.00958677785775002NN
rapidly0RB

The retardation factors in table D

Label: 0, with a score of: 1

for WAZ to are within the bounds often found in the research literature

Label: 9, with a score of: 0.846812573620657
WordScorePoS
research0.104016094894625NN

Label: 7, with a score of: 0.430462888793871
WordScorePoS
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The calculation is as follows

Label: 0, with a score of: 1

The calculation is as follows

Label: 0, with a score of: 1

working life from to years is applied

Label: 3, with a score of: 0.474829989267868
WordScorePoS
life0.0250390290383647NN

Label: 12, with a score of: 0.47422540942626
WordScorePoS
life0.0250071479597636NN

Annual income is approximated by GDP per capita

Label: 10, with a score of: 0.698728761084608
WordScorePoS
income0.166475342664294NN
gdp0NN
capita0NN

Label: 9, with a score of: 0.464416424475131
WordScorePoS
income0.110649350233433NN
gdp0NN
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Income is discounted at percent

Label: 10, with a score of: 0.756711939782219
WordScorePoS
income0.166475342664294NN

Label: 9, with a score of: 0.502955471427553
WordScorePoS
income0.110649350233433NN

Real income growth is percent per year

Label: 10, with a score of: 0.697363112976303
WordScorePoS
income0.166475342664294NN
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Label: 8, with a score of: 0.522702217707543
WordScorePoS
income0NN
growth0.208565600657229NN

Label: 9, with a score of: 0.342477481423124
WordScorePoS
income0.110649350233433NN
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The methodology for this part of the analysis which estimates effects of stunting partly attributed to repeated infections on cognition and learning has benefited from comments by Harold Alderman senior adviser Africa Region Human Development Department World Bank

Label: 4, with a score of: 0.493849122791334
WordScorePoS
estimate0.0299609328954485NN
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Label: 1, with a score of: 0.314344566608473
WordScorePoS
estimate0NN
effect0NN
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infection0NN
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africa0IN
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Label: 2, with a score of: 0.513856578456889
WordScorePoS
estimate0NN
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Label: 3, with a score of: 0.488889764888996
WordScorePoS
estimate0.059903311017139NN
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stunt0NN
infection0.122222546933424NN
learn0VB
benefit0NN
africa0IN
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On time enrollment grade attainment and high school completion rates in Cebu are relatively high percent on time less than years enrollment

Label: 4, with a score of: 0.675538626684537
WordScorePoS
time0NN
school0.208127520578185NN
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Label: 16, with a score of: 0.329494002984011
WordScorePoS
time0NN
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years of schooling and percent high school completion rate

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WordScorePoS
schooling0NN
school0.208127520578185NN
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Label: 16, with a score of: 0.37611612670602
WordScorePoS
schooling0NN
school0.0548954478802642NN
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Label: 5, with a score of: 0.312467193736641
WordScorePoS
schooling0NN
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An average child in Ghana starts school at the age of about seven and has seven to eight years of schooling World Bank

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WordScorePoS
average0NN
child0.076326555629389NN
school0.208127520578185NN
age0.0255262687343935NN
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Label: 10, with a score of: 0.336451316695314
WordScorePoS
average0.146608885563018NN
child0.0242343960710022NN
school0NN
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Label: 13, with a score of: 0.293566137975468
WordScorePoS
average0.1656430212089NN
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age0NN
schooling0NN
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Label: 3, with a score of: 0.412595646150994
WordScorePoS
average0NN
child0.10682408961305NN
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age0.0893142758861673NN
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Label: 2, with a score of: 0.38455314469629
WordScorePoS
average0NN
child0.0546336178945768NN
school0.0297950283197006NN
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schooling0NN
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The average age of leaving school is therefore around years

Label: 4, with a score of: 0.565142888376469
WordScorePoS
average0NN
age0.0255262687343935NN
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Label: 10, with a score of: 0.403613979339263
WordScorePoS
average0.146608885563018NN
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Label: 13, with a score of: 0.400643942992808
WordScorePoS
average0.1656430212089NN
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Label: 16, with a score of: 0.392766783996723
WordScorePoS
average0NN
age0NN
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Cost of schooling is the private and public costs of schooling

Label: 10, with a score of: 0.46839257390182
WordScorePoS
cost0.0660824365173543NN
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Label: 16, with a score of: 0.433935095656226
WordScorePoS
cost0.0548954478802642NN
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Label: 17, with a score of: 0.404281664976838
WordScorePoS
cost0NN
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Label: 5, with a score of: 0.40319910870136
WordScorePoS
cost0NN
schooling0NN
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Label: 3, with a score of: 0.323470483755908
WordScorePoS
cost0NN
schooling0.0407408489778079NN
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Notice that there is possibility of underestimation of damages linked to impaired cognitive development

Label: 0, with a score of: 1

In fact income earners with impaired cognitive development are more likely to have lower income than others with the same educational achievement

Label: 10, with a score of: 0.65212284162433
WordScorePoS
income0.166475342664294NN
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Label: 9, with a score of: 0.541435697706711
WordScorePoS
income0.110649350233433NN
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Label: 1, with a score of: 0.331991607203185
WordScorePoS
income0.0442083771593746NN
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The negative wage effect for income earners with impaired cognitive development as consequence of early childhood malnutrition may therefore be larger than that reflected in the studies reviewed by Psacharopoulos and Patrinos if those studies did not control for cognitive functioning

Label: 10, with a score of: 0.490855680975144
WordScorePoS
wage0.064698038783335NN
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income0.166475342664294NN
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Delayed school enrollment may affect grade attainment and thus schooling cost

Label: 4, with a score of: 0.721079584339634
WordScorePoS
school0.208127520578185NN
affect0.0125233923809486VB
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Label: 16, with a score of: 0.466738798379741
WordScorePoS
school0.0548954478802642NN
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Label: 5, with a score of: 0.304320042707064
WordScorePoS
school0.0931221694711702NN
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schooling0NN
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However including such an effect here would involve double counting because grade attainment is dealt with separately

Label: 0, with a score of: 1

Increased grade repetition as consequence of poor nutrition status is equivalent to an average of one month of school year per child with severe stunting status and one week per child with mild stunting status

Label: 2, with a score of: 0.668680542553393
WordScorePoS
increase0.0128868286091919NN
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child0.0546336178945768NN
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Label: 4, with a score of: 0.385447848343032
WordScorePoS
increase0.0144029596227568NN
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Label: 10, with a score of: 0.353970775189596
WordScorePoS
increase0.00285817158600878NN
poor0JJ
nutrition0NN
status0.0488696285210061NN
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Label: 1, with a score of: 0.24734409540746
WordScorePoS
increase0NN
poor0.150659516460257JJ
nutrition0NN
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Label: 13, with a score of: 0.185103838704949
WordScorePoS
increase0.0145316075945746NN
poor0JJ
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child0NN
stunt0NN

The additional schooling cost of grade repetition is therefore ignored here because it is minimal compared with the costs related to grade attainment

Label: 0, with a score of: 1

These amounts are estimated from the Ghana DHS

Label: 3, with a score of: 0.626183496955431
WordScorePoS
amount0.020806307400253NN
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Label: 1, with a score of: 0.47652432032895
WordScorePoS
amount0.0614198493690006NN
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Label: 16, with a score of: 0.425904919322368
WordScorePoS
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P D X Methodological Aspects of Assessing Environmental Health Burden of Disease THIS APPENDIX CONSISTS OF TWO SECTIONS that provide details on certain methodological aspects of the analysis to estimate the environmental health burden of disease

Label: 3, with a score of: 0.890365784207625
WordScorePoS
aspect0.0307735781890304NN
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health0.191387734041787NN
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The first section relates to how one gets from relative risks RRs to attributable fractions AFs

Label: 11, with a score of: 0.823979964851217
WordScorePoS
relative0.0731385760866977JJ
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Environmental risk factor AFs for Ghana and Pakistan are discussed in chapter and detailed methodology is described in appendix D

Label: 11, with a score of: 0.629443494824611
WordScorePoS
environmental0.0537696560159885JJ
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The second section discusses possible way to get around the biased estimates of RRs

Label: 3, with a score of: 0.765883642519583
WordScorePoS
estimate0.059903311017139NN

Unbiased estimates of RRs are used to calculate the AFs in table

Label: 0, with a score of: 1

From Relative Risks to Attributable Fractions The burden of disease methodology aims at estimating the effects of selected risk factors on mortality and disease

Label: 3, with a score of: 0.931111424168522
WordScorePoS
relative0JJ
risk0.0703902516159815NN
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It applies disability weights to combine deaths and illness into single metric disability adjusted life years DALYs

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WordScorePoS
disability0NN
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The environmental burden of disease is obtained by limiting the analysis to environmental risk factors

Label: 3, with a score of: 0.658273331182234
WordScorePoS
environmental0JJ
burden0NN
disease0.215415047323213NN
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Label: 11, with a score of: 0.393211117741566
WordScorePoS
environmental0.0537696560159885JJ
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Label: 1, with a score of: 0.323290619363632
WordScorePoS
environmental0.0442083771593746JJ
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The World Health Organization Comparative Risk Assessment WHO considers six environmental risk factors and puts them in relation to the diseases identified in the table E

Label: 3, with a score of: 0.831305758219206
WordScorePoS
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
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disease0.215415047323213NN
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Label: 11, with a score of: 0.30737945495125
WordScorePoS
world0.00626002771693937NN
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organization0NN
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For each pair of risk factors and diseases the Comparative Risk Assessment defines relative risk that is the probability of disease or death from that disease for example diarrhea occurring in group exposed to risk factor ENVIRONMENTAL HEALTH AND CHILD SURVIVAL TABLE E

Label: 3, with a score of: 0.893195148735479
WordScorePoS
risk0.0703902516159815NN
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Environmental Risk Factors and Related Diseases Included in the WHO Comparative Risk Assessment Risk Factor Related Diseases Outdoor air pollution Respiratory infections selected cardiopulmonary diseases lung cancer Indoor air pollution Chronic obstructive pulmonary disease lower respiratory infections lung cancer Lead Mild mental retardation cardiovascular diseases Water sanitation Diarrheal diseases trachoma schistosomiasis ascariasis and hygiene trichuriasis hookworm disease Climate change Diarrheal diseases malaria selected unintentional injuries protein energy malnutrition Selected occupational risk factors Injuries Unintentional injuries Noise Hearing loss Carcinogens Cancers Airborne particulates Asthma chronic obstructive pulmonary disease Ergonomic stressors Lower back pain Source WHO

Label: 3, with a score of: 0.718680441287618
WordScorePoS
environmental0JJ
risk0.0703902516159815NN
related0.0125195145191824JJ
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air0.020806307400253NN
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Label: 6, with a score of: 0.579103100745877
WordScorePoS
environmental0JJ
risk0NN
related0.0524959536790166JJ
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climate0NN
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injury0NN
protein0NN
energy0.0153390539205676NN
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source0.0613562156822703NN

Label: 7, with a score of: 0.185780859263321
WordScorePoS
environmental0JJ
risk0NN
related0JJ
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include0VB
air0NN
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energy0.494617163780726NN
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Label: 13, with a score of: 0.184649019489877
WordScorePoS
environmental0JJ
risk0NN
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air0NN
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Label: 12, with a score of: 0.147186166216768
WordScorePoS
environmental0.0598270388037045JJ
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for example inadequate water sanitation and hygiene versus the probability of the same event occurring in group that was not exposed

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WordScorePoS
inadequate0.0836717266454039JJ
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Label: 12, with a score of: 0.19610426057083
WordScorePoS
inadequate0JJ
water0.186896403054502NN
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RR Pr Disease Exposed Pr Disease Nonexposed E

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WordScorePoS
disease0.215415047323213NN

Label: 6, with a score of: 0.432155535187786
WordScorePoS
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So for example relative risk of

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WordScorePoS
relative0.0731385760866977JJ
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Label: 3, with a score of: 0.425466304459037
WordScorePoS
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risk0.0703902516159815NN

Label: 1, with a score of: 0.313992240775287
WordScorePoS
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of mortality from ALRI from indoor air pollution IAP means that the probability of person contracting ALRI after being exposed is

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WordScorePoS
mortality0.276962203701274NN
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means0NNS
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Label: 11, with a score of: 0.411312944437226
WordScorePoS
mortality0NN
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person0.107539312031977NN

Label: 1, with a score of: 0.383327210006126
WordScorePoS
mortality0NN
air0NN
pollution0NN
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times higher than the probability of the same person contracting ALRI if not exposed

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WordScorePoS
time0NN
person0.107539312031977NN

Label: 10, with a score of: 0.530962418808148
WordScorePoS
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RRs which are typically obtained from epidemiology studies and expert forums are reported for both mortality and morbidity and constitute the basic building block of the estimation of burden of disease

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WordScorePoS
typically0RB
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Label: 17, with a score of: 0.295529658606195
WordScorePoS
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Information on exposure to risk factor for example the number of children under five years of age exposed to IAP is combined with the RRs to estimate the risk AF of death or illness

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WordScorePoS
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Label: 1, with a score of: 0.459622932628033
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exposure0.120266261535276NN
risk0.0519476926891779NN
child0.0450489732120807NN
age0.112994637345193NN
estimate0NN
death0NN
illness0NN

For example suppose one wants to attribute deaths from acute respiratory infections ARI in children under five to exposure to IAP

Label: 3, with a score of: 0.864494430416031
WordScorePoS
death0.193573191943949NN
infection0.122222546933424NN
child0.10682408961305NN
exposure0NN

Label: 1, with a score of: 0.338162315318925
WordScorePoS
death0NN
infection0NN
child0.0450489732120807NN
exposure0.120266261535276NN

The standard definition of the fraction of ARI deaths attributable to IAP is AF Excess deaths attributable to IAP Total ARI deaths Excess deaths attributable to IAP Deaths in exposed population based on RR Deaths in exposed population if no exposure E

Label: 3, with a score of: 0.876468557446185
WordScorePoS
standard0NN
definition0NN
death0.193573191943949NN
total0NN
population0NN
base0.0149758277542848NN
exposure0NN

METHODOLOGICAL ASPECTS OF ASSESSING ENVIRONMENTAL HEALTH BURDEN OF DISEASE The fraction of deaths attributable to IAP is the ratio of excess deaths caused by that pollution to total ARI deaths

Label: 3, with a score of: 0.90739816909102
WordScorePoS
aspect0.0307735781890304NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
death0.193573191943949NN
ratio0.0615471563780609NN
cause0NN
pollution0.0175975629039954NN
total0NN

Excess deaths attributable to IAP is the difference between deaths in the exposed population based on estimated RR minus deaths in the exposed population if there were no exposure that is if the RR were

Label: 3, with a score of: 0.849729537604086
WordScorePoS
death0.193573191943949NN
population0NN
base0.0149758277542848NN
estimate0.059903311017139NN
exposure0NN

The AF defined in equations E

Label: 0, with a score of: 1

can be written as follows

Label: 0, with a score of: 1

Let equal the population of interest for example children under five in Ghana and be the proportion of the population exposed to the risk factor for example IAP

Label: 10, with a score of: 0.390429597223227
WordScorePoS
equal0.0202620733250388JJ
population0.0860640399817412NN
child0.0242343960710022NN
proportion0NN
risk0NN

Label: 5, with a score of: 0.375519738513442
WordScorePoS
equal0.114211783066808JJ
population0.024255976440725NN
child0.0170753354211044NN
proportion0.0285529457667019NN
risk0NN

Label: 8, with a score of: 0.37212800290258
WordScorePoS
equal0.0504071033101074JJ
population0.0428212738652355NN
child0.0452169560888236NN
proportion0.0252035516550537NN
risk0NN

Label: 3, with a score of: 0.365391867592918
WordScorePoS
equal0JJ
population0NN
child0.10682408961305NN
proportion0.025518364538905NN
risk0.0703902516159815NN

Label: 2, with a score of: 0.321650267231498
WordScorePoS
equal0.0182713919265625JJ
population0.0310434135749871NN
child0.0546336178945768NN
proportion0.0182713919265625NN
risk0.0252000451111224NN

Label: 1, with a score of: 0.310589619521249
WordScorePoS
equal0.0376648791150643JJ
population0NN
child0.0450489732120807NN
proportion0.0376648791150643NN
risk0.0519476926891779NN

Let be the death rate from ARI in the unexposed population RR is the death rate from ARI in the exposed population

Label: 3, with a score of: 0.754346450768732
WordScorePoS
death0.193573191943949NN
rate0.0433561464459019NN
population0NN

Then from equation E

Label: 0, with a score of: 1

Excess deaths attributable to IAP NP RR NPm NP RR E

Label: 3, with a score of: 0.943076411809307
WordScorePoS
death0.193573191943949NN

Total deaths attributable to ARI NP RR NP RR Nm Dividing the right hand side of equation E

Label: 3, with a score of: 0.846293968871471
WordScorePoS
total0NN
death0.193573191943949NN

by total deaths gives AF from IAP [NP RR m] [NP RR Nm] E

Label: 3, with a score of: 0.846293968871471
WordScorePoS
total0NN
death0.193573191943949NN

Canceling and from the numerator and denominator yields the standard formula AF from IAP RR [P RR ] E

Label: 0, with a score of: 1

Equation E

Label: 0, with a score of: 1

generalizes when there is more than one exposure category for example exposure to indoor smoke in an unventilated kitchen and exposure to indoor smoke in ventilated kitchen to ∑ RR − AF ∑ RR E

Label: 0, with a score of: 1

where Pi is the population exposed to level of the risk factor and RRi is the relative risk of dying from the selected disease by being exposed to level of the risk factor

Label: 3, with a score of: 0.703031970963007
WordScorePoS
population0NN
level0NN
risk0.0703902516159815NN
relative0JJ
die0.0748292956291867VB
disease0.215415047323213NN

Label: 11, with a score of: 0.41501434179123
WordScorePoS
population0.0194583992186006NN
level0.00692515656684925NN
risk0.0631828116343571NN
relative0.0731385760866977JJ
die0VB
disease0NN

Label: 6, with a score of: 0.331177297508249
WordScorePoS
population0.0363595928905615NN
level0.00647010760354177NN
risk0NN
relative0JJ
die0.0836717266454039VB
disease0.103230094596636NN

It is important to note that equation E

Label: 0, with a score of: 1

also applies when there are multiple risk factors and when exposure categories represent different combinations of exposure to risk factors

Label: 1, with a score of: 0.846311840532024
WordScorePoS
multiple0JJ
risk0.0519476926891779NN
exposure0.120266261535276NN
represent0VB

generalized version of equation E

Label: 0, with a score of: 1

is AF ∑ Pi RRi − ∑ RR ′ ∑ Pi RRi E

Label: 0, with a score of: 1

ENVIRONMENTAL HEALTH AND CHILD SURVIVAL where the subindex denotes exposure category Pi is the population current exposure distribution P′i is the population exposure distribution after controlling one or more risk factors that is exposure distribution in the absence of environmental risks and RRi is the risk of mortality in each exposure category

Label: 3, with a score of: 0.569239881626221
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
exposure0NN
population0NN
current0JJ
control0.020806307400253NN
risk0.0703902516159815NN
mortality0.276962203701274NN

Label: 1, with a score of: 0.671436249565209
WordScorePoS
environmental0.0442083771593746JJ
health0NN
child0.0450489732120807NN
exposure0.120266261535276NN
population0NN
current0JJ
control0.0614198493690006NN
risk0.0519476926891779NN
mortality0NN

A major advantage of equation E

Label: 7, with a score of: 0.501245427035275
WordScorePoS
major0.0325677023224526JJ

is that it allows estimation of the AF of target risk factor such as IAP while leaving other risk factors such as malnutrition that is not environmentally attributable unchanged

Label: 0, with a score of: 1

This advantage is exploited in estimating the burden of disease for Ghana and Pakistan in this report

Label: 3, with a score of: 0.908561676128368
WordScorePoS
estimate0.059903311017139NN
burden0NN
disease0.215415047323213NN
report0.0307735781890304NN

Label: 6, with a score of: 0.306414173588026
WordScorePoS
estimate0NN
burden0NN
disease0.103230094596636NN
report0NN

Dealing with Biased Estimates of Relative Risk There is second problem relating to this study in estimating both the direct and indirect effects of environmental risk factors

Label: 11, with a score of: 0.609608430141366
WordScorePoS
estimate0NN
relative0.0731385760866977JJ
risk0.0631828116343571NN
study0NN
direct0.04477822029736JJ
effect0NN
environmental0.0537696560159885JJ

The RRs of mortality from exposure to IAP and from malnutrition are usually calculated in separate epidemiological studies in which the other risk factor is not controlled for

Label: 3, with a score of: 0.730406400636662
WordScorePoS
mortality0.276962203701274NN
exposure0NN
malnutrition0NN
study0NN
risk0.0703902516159815NN
control0.020806307400253NN

Label: 1, with a score of: 0.609597347575008
WordScorePoS
mortality0NN
exposure0.120266261535276NN
malnutrition0.0736315832425121NN
study0NN
risk0.0519476926891779NN
control0.0614198493690006NN

For example most of the studies of ALRI that is caused by IAP that are reviewed in Desai Mehta and Smith do not control for nutritional status

Label: 5, with a score of: 0.550819902576037
WordScorePoS
study0NN
cause0NN
review0.0688661930304451NN
control0.0465610847355851NN
nutritional0JJ
status0NN

In the study by Fishman and others of the impact of malnutrition on ALRI there is no control for IAP

Label: 1, with a score of: 0.624030022962847
WordScorePoS
study0NN
impact0NN
malnutrition0.0736315832425121NN
control0.0614198493690006NN

Label: 15, with a score of: 0.424725097483256
WordScorePoS
study0.0517339898971162NN
impact0.0137637438743113NN
malnutrition0NN
control0.0264204925485796NN

Label: 12, with a score of: 0.400159967671581
WordScorePoS
study0NN
impact0.0866018859977851NN
malnutrition0NN
control0NN

In econometric jargon this problem is referred to as the omitted variable bias problem

Label: 0, with a score of: 1

If there is positive correlation between malnutrition and exposure to IAP the RR in each of the studies is likely to overstate the impact of the risk factor studied relative to study in which both risk factors are included

Label: 1, with a score of: 0.588365392391419
WordScorePoS
positive0JJ
malnutrition0.0736315832425121NN
exposure0.120266261535276NN
study0NN
impact0NN
risk0.0519476926891779NN
relative0JJ
include0VB

Label: 11, with a score of: 0.541766410831782
WordScorePoS
positive0.055245183797332JJ
malnutrition0NN
exposure0NN
study0NN
impact0.0194583992186006NN
risk0.0631828116343571NN
relative0.0731385760866977JJ
include0VB

This problem is difficult to correct second best approach is suggested here which is based on the properties of least squares estimators in the presence of omitted variables

Label: 1, with a score of: 0.627597155033708
WordScorePoS
correct0JJ
approach0NN
suggest0VB
base0.0442083771593746NN
property0.0736315832425121NN

The estimates in Fishman and others of the effect of malnutrition on mortality from various diseases are very likely biased because they fail to control for other risk factors

Label: 3, with a score of: 0.909569543059303
WordScorePoS
estimate0.059903311017139NN
effect0NN
malnutrition0NN
mortality0.276962203701274NN
disease0.215415047323213NN
control0.020806307400253NN
risk0.0703902516159815NN

If the estimate of the relative risk of death from ALRI attributable to malnutrition ignores IAP malnutrition will pick up its effects because malnutrition and exposure to IAP are correlated in most populations

Label: 3, with a score of: 0.50743746050323
WordScorePoS
estimate0.059903311017139NN
relative0JJ
risk0.0703902516159815NN
death0.193573191943949NN
malnutrition0NN
effect0NN
exposure0NN
population0NN

Label: 1, with a score of: 0.615926394469257
WordScorePoS
estimate0NN
relative0JJ
risk0.0519476926891779NN
death0NN
malnutrition0.0736315832425121NN
effect0NN
exposure0.120266261535276NN
population0NN

For policy purposes there are at least four risk factors whose impact on ALRI deaths might need to be estimated exposure to IAP malnutrition crowding and poor medical treatment received when ill

Label: 3, with a score of: 0.619781163628449
WordScorePoS
policy0NN
risk0.0703902516159815NN
impact0NN
death0.193573191943949NN
estimate0.059903311017139NN
exposure0NN
malnutrition0NN
poor0JJ
treatment0.0624189222007589NN
receive0.0814816979556159VB

Label: 1, with a score of: 0.585049072524935
WordScorePoS
policy0.0450489732120807NN
risk0.0519476926891779NN
impact0NN
death0NN
estimate0NN
exposure0.120266261535276NN
malnutrition0.0736315832425121NN
poor0.150659516460257JJ
treatment0NN
receive0VB

These factors are all important and all have policy significance

Label: 10, with a score of: 0.635957531166171
WordScorePoS
policy0.0848203862485078NN

Label: 17, with a score of: 0.480993629941572
WordScorePoS
policy0.0641521854453136NN

Label: 8, with a score of: 0.339023023036556
WordScorePoS
policy0.0452169560888236NN

Label: 1, with a score of: 0.337763538373769
WordScorePoS
policy0.0450489732120807NN

Because poor children are likely to be at risk for all four factors omitting three of them makes it likely that malnutrition will pick up their effects thus overstating the impact of malnutrition

Label: 1, with a score of: 0.671358282148556
WordScorePoS
poor0.150659516460257JJ
child0.0450489732120807NN
risk0.0519476926891779NN
malnutrition0.0736315832425121NN
effect0NN
impact0NN

Label: 2, with a score of: 0.425259172784635
WordScorePoS
poor0.0548141757796873JJ
child0.0546336178945768NN
risk0.0252000451111224NN
malnutrition0.0357189919948307NN
effect0.0440683498519077NN
impact0NN

Label: 6, with a score of: 0.325800150298915
WordScorePoS
poor0.0642010940957526JJ
child0.0255958462813622NN
risk0NN
malnutrition0.041835863322702NN
effect0NN
impact0.0181797964452808NN

Label: 3, with a score of: 0.301262311018958
WordScorePoS
poor0JJ
child0.10682408961305NN
risk0.0703902516159815NN
malnutrition0NN
effect0NN
impact0NN

In most studies one could reduce this bias by using family income or assets or mother education as proxy for the omitted factors even if the factors could not be estimated directly

Label: 3, with a score of: 0.556921947409775
WordScorePoS
study0NN
reduce0.01675146888405VB
family0.0624189222007589NN
income0NN
asset0NN
mother0.162963395911232NN
education0.0152605842304358NN
estimate0.059903311017139NN

Label: 4, with a score of: 0.481287127013229
WordScorePoS
study0NN
reduce0VB
family0NN
income0NN
asset0NN
mother0NN
education0.244244978014045NN
estimate0.0299609328954485NN

Label: 10, with a score of: 0.45371621719969
WordScorePoS
study0NN
reduce0.0310356414389692VB
family0NN
income0.166475342664294NN
asset0.0488696285210061NN
mother0NN
education0.0121171980355011NN
estimate0NN

The only way to solve this omitted variable bias problem is to find studies that have controlled for other risk factors or have proxied for them in addition to malnutrition

Label: 1, with a score of: 0.663789168472174
WordScorePoS
study0NN
control0.0614198493690006NN
risk0.0519476926891779NN
addition0NN
malnutrition0.0736315832425121NN

Label: 15, with a score of: 0.469176649159824
WordScorePoS
study0.0517339898971162NN
control0.0264204925485796NN
risk0.0223459295604043NN
addition0.0316735178673487NN
malnutrition0NN

METHODOLOGICAL ASPECTS OF ASSESSING ENVIRONMENTAL HEALTH BURDEN OF DISEASE To understand the nature of the bias suppose that in the correct model IAP MAL E

Label: 3, with a score of: 0.796929320481727
WordScorePoS
aspect0.0307735781890304NN
environmental0JJ
health0.191387734041787NN
burden0NN
disease0.215415047323213NN
nature0NN
correct0JJ

Label: 12, with a score of: 0.467263491963727
WordScorePoS
aspect0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
disease0NN
nature0.162755901889551NN
correct0JJ

where death rate attributable to ALRI or the logarithm of the death rate

Label: 3, with a score of: 0.856547921137624
WordScorePoS
death0.193573191943949NN
rate0.0433561464459019NN

Label: 16, with a score of: 0.374625532797261
WordScorePoS
death0.0464294830712827NN
rate0.0571955184484387NN

It is well known that if malnutrition MAL is dropped from this equation and IAP E

Label: 1, with a score of: 0.80111525733011
WordScorePoS
malnutrition0.0736315832425121NN

is estimated instead that the least squares estimator of that is βˆ is related to the least squares estimators of the coefficients in equation E

Label: 0, with a score of: 1

as follows βˆ γˆ γˆ δˆ E

Label: 0, with a score of: 1

where δˆ is the coefficient of IAP in regression of MAL on IAP

Label: 0, with a score of: 1

This equation implies that if γˆ > and δˆ > βˆ will be biased upward indoor air pollution will capture the effects of malnutrition

Label: 0, with a score of: 1

This situation is likely in practice since indoor air pollution and malnutrition are positively correlated in most populations

Label: 6, with a score of: 0.440934104573497
WordScorePoS
situation0.0295155485671997NN
practice0NN
air0NN
pollution0.0590310971343993NN
malnutrition0.041835863322702NN
positively0RB
population0.0363595928905615NN

Label: 12, with a score of: 0.43257395927837
WordScorePoS
situation0NN
practice0.0703006268489394NN
air0.0554128417527413NN
pollution0.0234335422829798NN
malnutrition0NN
positively0RB
population0.0144336476662975NN

Label: 11, with a score of: 0.400850981964007
WordScorePoS
situation0.0631828116343571NN
practice0NN
air0.0373517915079663NN
pollution0.0315914058171786NN
malnutrition0NN
positively0RB
population0.0194583992186006NN

Label: 1, with a score of: 0.332082809020847
WordScorePoS
situation0.0519476926891779NN
practice0NN
air0NN
pollution0NN
malnutrition0.0736315832425121NN
positively0RB
population0NN

Label: 14, with a score of: 0.314901441920252
WordScorePoS
situation0NN
practice0.0229784274580034NN
air0.0271683202880942NN
pollution0.0689352823740101NN
malnutrition0NN
positively0RB
population0NN

Label: 2, with a score of: 0.309825410489589
WordScorePoS
situation0.0252000451111224NN
practice0.0252000451111224NN
air0NN
pollution0NN
malnutrition0.0357189919948307NN
positively0RB
population0.0310434135749871NN

Label: 10, with a score of: 0.301487996130455
WordScorePoS
situation0NN
practice0.02794560829783NN
air0NN
pollution0NN
malnutrition0NN
positively0RB
population0.0860640399817412NN

similar argument can be made for model in which IAP is dropped from equation E

Label: 0, with a score of: 1

In such case the coefficient for MAL will be biased as it captures the effect of IAP

Label: 0, with a score of: 1

In the calculation of the total cost of environmental health risk in chapter relative risks are corrected by using these econometric results

Label: 3, with a score of: 0.604655243643231
WordScorePoS
total0NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
relative0JJ
correct0JJ
result0NN

Label: 11, with a score of: 0.50273704842919
WordScorePoS
total0NN
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
relative0.0731385760866977JJ
correct0JJ
result0NN

Label: 12, with a score of: 0.30650998956469
WordScorePoS
total0.0468670845659596NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
relative0JJ
correct0JJ
result0NN

Although this solution is second best it is done in order to provide conservative estimates

Label: 9, with a score of: 0.644774992801384
WordScorePoS
solution0.0368585655748969NN
provide0.00740117451847634VB
conservative0.0602029956716497JJ
estimate0.0221298700466866NN

Label: 3, with a score of: 0.356126182912062
WordScorePoS
solution0NN
provide0.0100171139310145VB
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estimate0.059903311017139NN

Label: 13, with a score of: 0.341912831067139
WordScorePoS
solution0.0671298309154199NN
provide0VB
conservative0JJ
estimate0NN

Label: 15, with a score of: 0.323612996561137
WordScorePoS
solution0NN
provide0.0445201436316848VB
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estimate0.0190167691930804NN

Notes This appendix is based on detailed comments and guidance from Maureen Cropper

Label: 0, with a score of: 1

To distinguish environmental risk factors from nonenvironmental risk factors one has to define environment

Label: 11, with a score of: 0.591351729557181
WordScorePoS
environmental0.0537696560159885JJ
risk0.0631828116343571NN
environment0.0268848280079943NN

Label: 1, with a score of: 0.423057534246107
WordScorePoS
environmental0.0442083771593746JJ
risk0.0519476926891779NN
environment0NN

Label: 12, with a score of: 0.398756370954573
WordScorePoS
environmental0.0598270388037045JJ
risk0NN
environment0.079769385071606NN

This report follows Prüss Üstün and Corvalán by defining environment as all the physical chemical and biological factors external to person and all the related behaviors

Label: 12, with a score of: 0.541558530612941
WordScorePoS
report0.0409791940864438NN
environment0.079769385071606NN
chemical0.0332151194779746NN
biological0JJ
external0JJ
person0NN
related0.00833571598658786JJ

Label: 11, with a score of: 0.486042189244
WordScorePoS
report0NN
environment0.0268848280079943NN
chemical0NN
biological0JJ
external0JJ
person0.107539312031977NN
related0.0112376090361851JJ

Pelletier has demonstrated that estimates are robust when wide array of variables is controlled for

Label: 3, with a score of: 0.624559541719054
WordScorePoS
estimate0.059903311017139NN
wide0.0307735781890304JJ
array0NN
control0.020806307400253NN

Label: 13, with a score of: 0.539129696181766
WordScorePoS
estimate0NN
wide0.0414107553022249JJ
array0.0548233071065585NN
control0NN

Notice that IAP could also contribute to malnutrition through repeated respiratory infections

Label: 3, with a score of: 0.637645354710585
WordScorePoS
contribute0VB
malnutrition0NN
infection0.122222546933424NN

Label: 14, with a score of: 0.425218267700535
WordScorePoS
contribute0.0815049608642826VB
malnutrition0NN
infection0NN

Label: 1, with a score of: 0.384142191376099
WordScorePoS
contribute0VB
malnutrition0.0736315832425121NN
infection0NN

Multicollinearity will cause the estimated effect to be less robust although unbiased

Label: 9, with a score of: 0.613566459387801
WordScorePoS
estimate0.0221298700466866NN
effect0.0454743001434393NN

Label: 3, with a score of: 0.543674485509187
WordScorePoS
estimate0.059903311017139NN
effect0NN

P E D X Monetary Valuation of the Cost of Environmental Health Risks CHAPTER PROVIDES MONETARY ESTIMATES of the environmentally attributable burden of disease in Ghana and Pakistan

Label: 3, with a score of: 0.86039191975244
WordScorePoS
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
estimate0.059903311017139NN
environmentally0RB
burden0NN
disease0.215415047323213NN

The World Health Organization methodology for estimating burden of disease is powerful tool for decision makers

Label: 3, with a score of: 0.839694465069631
WordScorePoS
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
estimate0.059903311017139NN
burden0NN
disease0.215415047323213NN
tool0NN
decision0NN
maker0NN

Knowing the burden of disease makes it possible to compare policy options that act on different causes of death and have different mortality and morbidity impacts

Label: 3, with a score of: 0.916820471400659
WordScorePoS
burden0NN
disease0.215415047323213NN
compare0.0307735781890304VB
policy0NN
death0.193573191943949NN
mortality0.276962203701274NN
impact0NN

A major advantage of using burden of disease is that it requires no monetary valuation of the benefits of an intervention for example there is no need to know the value of life

Label: 3, with a score of: 0.745357515203651
WordScorePoS
major0.0108390366114755JJ
burden0NN
disease0.215415047323213NN
require0VB
benefit0NN
intervention0.0407408489778079NN
life0.0250390290383647NN

Label: 8, with a score of: 0.352366352717573
WordScorePoS
major0.0214106369326177JJ
burden0NN
disease0NN
require0.104282800328615VB
benefit0NN
intervention0NN
life0.0123650647908625NN

The main limitation of burden of disease is that it cannot be applied when one compares policies with outcomes measured in different metrics for example case in which one policy reduces diarrhea mortality while another policy increases children cognition and thus future income

Label: 3, with a score of: 0.591308758072987
WordScorePoS
burden0NN
disease0.215415047323213NN
compare0.0307735781890304VB
policy0NN
outcome0NN
measure0NN
reduce0.01675146888405VB
mortality0.276962203701274NN
increase0.0143984997539974NN
child0.10682408961305NN
future0NN
income0NN

Label: 10, with a score of: 0.501735400341487
WordScorePoS
burden0NN
disease0NN
compare0VB
policy0.0848203862485078NN
outcome0.0330412182586772NN
measure0NN
reduce0.0310356414389692VB
mortality0.0488696285210061NN
increase0.00285817158600878NN
child0.0242343960710022NN
future0NN
income0.166475342664294NN

Label: 1, with a score of: 0.308373217008765
WordScorePoS
burden0NN
disease0NN
compare0VB
policy0.0450489732120807NN
outcome0NN
measure0.103895385378356NN
reduce0.0164833460638534VB
mortality0NN
increase0NN
child0.0450489732120807NN
future0NN
income0.0442083771593746NN

In such cases the monetary valuation of burden of disease can be very useful

Label: 3, with a score of: 0.876741708634708
WordScorePoS
burden0NN
disease0.215415047323213NN

Label: 6, with a score of: 0.420147666766192
WordScorePoS
burden0NN
disease0.103230094596636NN

Monetary valuation has also been used extensively to express burden of disease in metric that is easy for policy makers with no background in public health to understand

Label: 3, with a score of: 0.76358672944367
WordScorePoS
burden0NN
disease0.215415047323213NN
policy0NN
maker0NN
public0.021678073222951NN
health0.191387734041787NN

Label: 10, with a score of: 0.34113798070207
WordScorePoS
burden0NN
disease0NN
policy0.0848203862485078NN
maker0.0488696285210061NN
public0.0172128079963482NN
health0.0405241466500776NN

Several approaches are available to value the impact of health risks

Label: 3, with a score of: 0.728227821013671
WordScorePoS
approach0NN
impact0NN
health0.191387734041787NN
risk0.0703902516159815NN

Label: 12, with a score of: 0.486365282018741
WordScorePoS
approach0.0542519672965169NN
impact0.0866018859977851NN
health0.0339811641917276NN
risk0NN

Traditionally valuation of health damages has been based on the calculation of the observed costs caused by death or illness

Label: 3, with a score of: 0.871289837823026
WordScorePoS
health0.191387734041787NN
base0.0149758277542848NN
cost0NN
cause0NN
death0.193573191943949NN
illness0.0407408489778079NN

â–  Death incapacity or illness is typically valued using the human capital approach which calculates the present value of forgone earnings

Label: 3, with a score of: 0.863730191887267
WordScorePoS
death0.193573191943949NN
illness0.0407408489778079NN
typically0RB
value0NN
human0JJ
approach0NN

For the sake of simplicity ENVIRONMENTAL HEALTH AND CHILD SURVIVAL many studies of the costs of environmental degradation have valued lost year of healthy life using gross domestic product per capita as proxy of the forgone annual earnings

Label: 15, with a score of: 0.448130313455947
WordScorePoS
environmental0JJ
health0NN
child0NN
study0.0517339898971162NN
cost0NN
degradation0.221714625071441NN
value0.0390772412228479NN
lose0.0781544824456958VB
healthy0JJ
life0.00794883334420673NN
gross0JJ
domestic0JJ
product0.0190167691930804NN
capita0NN

Label: 3, with a score of: 0.412884779719019
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
study0NN
cost0NN
degradation0NN
value0NN
lose0VB
healthy0.0615471563780609JJ
life0.0250390290383647NN
gross0JJ
domestic0JJ
product0NN
capita0NN

Label: 8, with a score of: 0.413180133389706
WordScorePoS
environmental0.0295821503613099JJ
health0NN
child0.0452169560888236NN
study0NN
cost0NN
degradation0.049270765107907NN
value0NN
lose0VB
healthy0JJ
life0.0123650647908625NN
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN
capita0.049270765107907NN

Label: 12, with a score of: 0.385366452347948
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN
child0NN
study0NN
cost0.0277064208763707NN
degradation0.0996453584339239NN
value0NN
lose0VB
healthy0JJ
life0.0250071479597636NN
gross0JJ
domestic0JJ
product0.0199423462679015NN
capita0.0332151194779746NN

Label: 11, with a score of: 0.332288843682812
WordScorePoS
environmental0.0537696560159885JJ
health0.0229054731708393NN
child0.0273960270556257NN
study0NN
cost0NN
degradation0NN
value0NN
lose0VB
healthy0JJ
life0.0112376090361851NN
gross0.0373517915079663JJ
domestic0.0315914058171786JJ
product0.0268848280079943NN
capita0.04477822029736NN

â–  Illness also results in expenses other than lost wages

Label: 15, with a score of: 0.651755665336248
WordScorePoS
illness0NN
result0NN
lose0.0781544824456958VB

Label: 6, with a score of: 0.5698483974598
WordScorePoS
illness0NN
result0.0683326727248364NN
lose0VB

The cost of illness approach measures such costs by estimating the change in costs incurred as result of change in the incidence of particular illness

Label: 13, with a score of: 0.876142403973626
WordScorePoS
cost0.0279982034978914NN
illness0NN
approach0NN
measure0.0710409787438328NN
estimate0NN
change0.402565546215053NN
incur0VB
result0NN
incidence0NN

Both direct costs such as cost of doctor visits and treatment and indirect costs such as loss of wages are included in the estimation

Label: 10, with a score of: 0.704523897625365
WordScorePoS
direct0.0396106020715138JJ
cost0.0660824365173543NN
treatment0.0330412182586772NN
loss0NN
include0VB

In cases where some of the costs are borne by medical insurance cost of illness measures will not be limited to patient out ofpocket expenses but should include the additional costs borne by the insurance company or treatment facility to capture the social benefits of the reduced risk

Label: 1, with a score of: 0.491817902791534
WordScorePoS
cost0NN
bear0NN
insurance0NN
illness0NN
measure0.103895385378356NN
limited0.120266261535276JJ
include0VB
additional0JJ
company0NN
treatment0NN
facility0NN
capture0NN
social0.112994637345193JJ
benefit0NN
reduce0.0164833460638534VB
risk0.0519476926891779NN

Label: 3, with a score of: 0.428371367364553
WordScorePoS
cost0NN
bear0.0814816979556159NN
insurance0NN
illness0.0407408489778079NN
measure0NN
limited0JJ
include0VB
additional0JJ
company0NN
treatment0.0624189222007589NN
facility0NN
capture0NN
social0JJ
benefit0NN
reduce0.01675146888405VB
risk0.0703902516159815NN

It is important to keep in mind that unit values should be expressed net of taxes and subsidies

Label: 14, with a score of: 0.761007141788595
WordScorePoS
value0NN
tax0NN
subsidy0.162850158165781NN

Label: 16, with a score of: 0.379419691477654
WordScorePoS
value0NN
tax0.0811931365363091NN
subsidy0NN

Label: 17, with a score of: 0.345446495616827
WordScorePoS
value0.036961556179878NN
tax0.036961556179878NN
subsidy0NN

Label: 12, with a score of: 0.310431913886977
WordScorePoS
value0NN
tax0NN
subsidy0.0664302389559493NN

Taxes and subsidies are transfers within the economy and should not be taken as component of the true economic value of an item

Label: 14, with a score of: 0.600625316446214
WordScorePoS
tax0NN
subsidy0.162850158165781NN
transfer0.0803666323453555NN
economy0NN
economic0.0141533244035107JJ

Label: 8, with a score of: 0.491623223740777
WordScorePoS
tax0NN
subsidy0NN
transfer0NN
economy0.0821985033584295NN
economic0.128463821595706JJ

So for example admissions in public hospitals that are free or subsidized can be valued by using comparable estimate from the private sector

Label: 17, with a score of: 0.720513619713949
WordScorePoS
public0.0390556786919513NN
free0.0898760357768464JJ
value0.036961556179878NN
estimate0NN
private0.0898760357768464JJ
sector0.0459744293658165NN

Label: 5, with a score of: 0.44340233117826
WordScorePoS
public0.0727679293221751NN
free0JJ
value0NN
estimate0NN
private0.0558185411034276JJ
sector0.0571058915334038NN

Label: 9, with a score of: 0.314163125050368
WordScorePoS
public0.0160169090870187NN
free0JJ
value0NN
estimate0.0221298700466866NN
private0.0368585655748969JJ
sector0.0565629593551219NN

Likewise measures of wage are taken net of labor taxes

Label: 1, with a score of: 0.578687894293203
WordScorePoS
measure0.103895385378356NN
wage0NN
tax0NN

Label: 16, with a score of: 0.452238422737931
WordScorePoS
measure0NN
wage0NN
tax0.0811931365363091NN

Label: 13, with a score of: 0.395691822577918
WordScorePoS
measure0.0710409787438328NN
wage0NN
tax0NN

Label: 10, with a score of: 0.360362221017642
WordScorePoS
measure0NN
wage0.064698038783335NN
tax0NN

More recently economists have started adopting estimates of willingness to pay WTP or willingness to accept compensation to value health damages

Label: 3, with a score of: 0.72005303957312
WordScorePoS
adopt0VB
estimate0.059903311017139NN
pay0NN
health0.191387734041787NN

Label: 5, with a score of: 0.471130686456874
WordScorePoS
adopt0.0285529457667019VB
estimate0NN
pay0.078760887431929NN
health0.0571058915334038NN

The human capital and cost of illness approaches take into account only the out ofpocket expenses paid as consequence of illness or death

Label: 3, with a score of: 0.666822499603795
WordScorePoS
human0JJ
cost0NN
illness0.0407408489778079NN
approach0NN
account0NN
pay0NN
death0.193573191943949NN

Label: 12, with a score of: 0.363294216632495
WordScorePoS
human0.0101607690729067JJ
cost0.0277064208763707NN
illness0NN
approach0.0542519672965169NN
account0.0577345906651901NN
pay0NN
death0NN

Label: 16, with a score of: 0.314974851201113
WordScorePoS
human0JJ
cost0.0548954478802642NN
illness0NN
approach0NN
account0.0285977592242194NN
pay0NN
death0.0464294830712827NN

They are based on the notion that individuals should at least be willing to pay those out of pocket expenses to avoid illness

Label: 14, with a score of: 0.558315651733613
WordScorePoS
base0.058665107245718NN
individual0JJ
pay0NN
avoid0.0531983120572613VB
illness0NN

Label: 10, with a score of: 0.462388853491107
WordScorePoS
base0NN
individual0.064698038783335JJ
pay0.02794560829783NN
avoid0VB
illness0NN

But individuals willingness to pay to avoid illness or death may be higher than their out of pocket expenses

Label: 3, with a score of: 0.791583329295491
WordScorePoS
individual0JJ
pay0NN
avoid0VB
illness0.0407408489778079NN
death0.193573191943949NN

Label: 10, with a score of: 0.312978113928194
WordScorePoS
individual0.064698038783335JJ
pay0.02794560829783NN
avoid0VB
illness0NN
death0NN

The WTP approach when correctly applied can capture people preferences to avoid pain and discomfort

Label: 0, with a score of: 1

It does so by looking at how they respond to risk of illness or death

Label: 3, with a score of: 0.916256605558775
WordScorePoS
risk0.0703902516159815NN
illness0.0407408489778079NN
death0.193573191943949NN

Typically valuation is determined either by observing behavior or by eliciting responses from questionnaire

Label: 0, with a score of: 1

Responses are then analyzed using econometric techniques to estimate willingness to pay

Label: 5, with a score of: 0.521494274621651
WordScorePoS
response0NN
estimate0NN
pay0.078760887431929NN

Despite its advantages the WTP approach produces much higher uncertainty regarding values and requires much closer scrutiny

Label: 12, with a score of: 0.653454429440912
WordScorePoS
approach0.0542519672965169NN
produce0.0332151194779746VB
value0NN
require0.0468670845659596VB

Label: 8, with a score of: 0.507272699933764
WordScorePoS
approach0NN
produce0VB
value0NN
require0.104282800328615VB

The WTP approach is also data intensive proper estimates require large and costly surveys and careful application of econometric methods

Label: 8, with a score of: 0.627968240107009
WordScorePoS
approach0NN
datum0NN
intensive0.0804764811724088JJ
proper0JJ
estimate0NN
require0.104282800328615VB
survey0NN
careful0JJ

For this reason studies in developing countries have commonly transferred WTP estimates from U

Label: 14, with a score of: 0.677849409502831
WordScorePoS
study0NN
develop0VB
country0NN
transfer0.0803666323453555NN
estimate0.0195550357485727NN

and European studies by accounting for differences in purchasing power and occasionally the income elasticity of consumption

Label: 12, with a score of: 0.679085138478567
WordScorePoS
study0NN
accounting0NN
power0NN
income0NN
consumption0.332151194779746NN

Label: 10, with a score of: 0.340359850884819
WordScorePoS
study0NN
accounting0NN
power0NN
income0.166475342664294NN
consumption0NN

Label: 8, with a score of: 0.302203137054212
WordScorePoS
study0NN
accounting0NN
power0NN
income0NN
consumption0.147812295323721NN

Label: 9, with a score of: 0.41216823632642
WordScorePoS
study0NN
accounting0.0454743001434393NN
power0.0454743001434393NN
income0.110649350233433NN
consumption0NN

An important limit to the application of the WTP approach is with regard to children life

Label: 3, with a score of: 0.515802830359078
WordScorePoS
limit0NN
approach0NN
regard0NN
child0.10682408961305NN
life0.0250390290383647NN

Label: 2, with a score of: 0.353428103232457
WordScorePoS
limit0.0357189919948307NN
approach0NN
regard0NN
child0.0546336178945768NN
life0NN

Label: 10, with a score of: 0.347872870577669
WordScorePoS
limit0NN
approach0NN
regard0.064698038783335NN
child0.0242343960710022NN
life0NN

Label: 4, with a score of: 0.347550210625155
WordScorePoS
limit0NN
approach0NN
regard0NN
child0.076326555629389NN
life0.0125233923809486NN

Label: 12, with a score of: 0.310034196059166
WordScorePoS
limit0NN
approach0.0542519672965169NN
regard0NN
child0NN
life0.0250071479597636NN

It is conceptually and practically very difficult to observe or measure monetarily children preferences

Label: 1, with a score of: 0.569801212681872
WordScorePoS
measure0.103895385378356NN
child0.0450489732120807NN

Label: 3, with a score of: 0.408666003742563
WordScorePoS
measure0NN
child0.10682408961305NN

Label: 2, with a score of: 0.401816724203756
WordScorePoS
measure0.0504000902222448NN
child0.0546336178945768NN

For this reason in this study valuation relies solely on the human capital approach

Label: 15, with a score of: 0.61072869740441
WordScorePoS
study0.0517339898971162NN
rely0.0316735178673487VB
human0.0193783617722719JJ
approach0NN

Label: 12, with a score of: 0.58008103157367
WordScorePoS
study0NN
rely0.0332151194779746VB
human0.0101607690729067JJ
approach0.0542519672965169NN

For simplicity the study does not look at cost of illness and it concentrates on the valuation of mortality

Label: 3, with a score of: 0.911861200885149
WordScorePoS
study0NN
cost0NN
illness0.0407408489778079NN
mortality0.276962203701274NN

Label: 10, with a score of: 0.329931762336537
WordScorePoS
study0NN
cost0.0660824365173543NN
illness0NN
mortality0.0488696285210061NN

Deaths in Ghana MONETARY VALUATION OF THE COST OF ENVIRONMENTAL HEALTH RISKS are valued using per capita income of US dollars

Label: 3, with a score of: 0.666778709464492
WordScorePoS
death0.193573191943949NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
value0NN
capita0NN
income0NN
dollar0NN

Label: 10, with a score of: 0.43470333005278
WordScorePoS
death0NN
cost0.0660824365173543NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN
value0NN
capita0NN
income0.166475342664294NN
dollar0NN

Label: 11, with a score of: 0.316625815686712
WordScorePoS
death0.0315914058171786NN
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
value0NN
capita0.04477822029736NN
income0NN
dollar0NN

In Pakistan per capita income of US dollars is used

Label: 10, with a score of: 0.690715698144468
WordScorePoS
capita0NN
income0.166475342664294NN
dollar0NN

Label: 9, with a score of: 0.459090469330567
WordScorePoS
capita0NN
income0.110649350233433NN
dollar0NN

Per capita income values are also used to estimate the present value of income losses from lower education attainment together with an assumed real rate of income growth of percent

Label: 10, with a score of: 0.653143392135174
WordScorePoS
capita0NN
income0.166475342664294NN
value0NN
estimate0NN
loss0NN
education0.0121171980355011NN
rate0.0172128079963482NN
growth0.11178243319132NN

Label: 4, with a score of: 0.301713424902522
WordScorePoS
capita0NN
income0NN
value0NN
estimate0.0299609328954485NN
loss0NN
education0.244244978014045NN
rate0.0216847879059514NN
growth0NN

Label: 8, with a score of: 0.278279155796823
WordScorePoS
capita0.049270765107907NN
income0NN
value0NN
estimate0NN
loss0NN
education0.0150723186962745NN
rate0NN
growth0.208565600657229NN

Label: 9, with a score of: 0.410555862248019
WordScorePoS
capita0NN
income0.110649350233433NN
value0NN
estimate0.0221298700466866NN
loss0NN
education0.022550656390892NN
rate0NN
growth0.0260040237236563NN

Note Some have argued that there is conceptual problem with the human capital approach in that most people value safety not out of concern for preserving current and future income levels but primarily because they have an aversion to pain suffering and death

Label: 3, with a score of: 0.391143104427146
WordScorePoS
human0JJ
approach0NN
people0.00539943740774902NNS
safety0NN
current0JJ
future0NN
income0NN
level0NN
primarily0RB
suffer0VB
death0.193573191943949NN

Label: 10, with a score of: 0.338496760956553
WordScorePoS
human0JJ
approach0NN
people0.00571634317201755NNS
safety0NN
current0JJ
future0NN
income0.166475342664294NN
level0NN
primarily0RB
suffer0VB
death0NN

Label: 11, with a score of: 0.37853354595645
WordScorePoS
human0.0273960270556257JJ
approach0NN
people0.0161552501392041NNS
safety0.0731385760866977NN
current0JJ
future0.0373517915079663NN
income0NN
level0.00692515656684925NN
primarily0RB
suffer0VB
death0.0315914058171786NN

References Adair L

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Popkin J

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Guilkey R

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Black J

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Briscoe and W

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Flieger

Label: 0, with a score of: 1

Growth Dynamics during the First Two Years of Life Prospective Study in the Philippines

Label: 8, with a score of: 0.815680991807359
WordScorePoS
growth0.208565600657229NN
life0.0123650647908625NN
study0NN

Label: 10, with a score of: 0.41270326048766
WordScorePoS
growth0.11178243319132NN
life0NN
study0NN

European Journal of Clinical Nutrition

Label: 2, with a score of: 1
WordScorePoS
nutrition0.175025014152344NN

Adjuik M

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Clark J

Label: 0, with a score of: 1

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Kinfu K

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Sacarlal N

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Gbangou E

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Mwageni and F

Label: 0, with a score of: 1

Binka

Label: 0, with a score of: 1

Cause Specific Mortality Rates in Sub Saharan Africa and Bangladesh

Label: 3, with a score of: 0.898793214329419
WordScorePoS
specific0JJ
mortality0.276962203701274NN
rate0.0433561464459019NN
saharan0.0299516555085695JJ
africa0IN

Bulletin of the World Health Organization

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Agarwal B

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Diffusion of Rural Innovations Some Analytical Issues and Case Study of Improved Woodburning Stoves

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World Development

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Cold Hearths and Barren Slopes Woodfuel Crisis in the Third World

Label: 0, with a score of: 1

New Delhi Allied Press

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Ahmed K

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Awe D

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Barnes M

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Cropper and M

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Kojima

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Environmental Health and Traditional Fuel Use in Guatemala

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Washington DC World Bank

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Ahmed N

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Zeitlin A

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Super and S

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Gershoff

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Longitudinal Study of the Impact of Behavioural Change Intervention on Cleanliness Diarrhoeal Morbidity and Growth of Children in Rural Bangladesh

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Social Science and Medicine

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Yunus and G

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Fuchs

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Association between Clinical Type of Diarrhoea and Growth of Children under Years in Rural Bangladesh

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rural0.148975141598503JJ

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International Journal of Epidemiology

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Alderman H

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Behrman V

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Lavy and R

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Menon

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Child Health and School Enrollment Longitudinal Analysis

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Journal of Human Resources

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Alderman H

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environmental0JJ
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Konde Lule I

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Sebuliba D

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Bundy and A

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Hall

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Effect on Weight Gain of Routinely Giving Albendazole to Preschool Children during Child Health Days in Uganda Cluster Randomised Controlled Trial

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effect0NN
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Label: 1, with a score of: 0.556142388357113
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British Medical Journal

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Allen S

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Raiko A

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O Donnell N

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Alexander and J

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Clegg

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Causes of Preterm Delivery and Intrauterine Growth Retardation in Malaria Endemic Region of Papua New Guinea

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Archive of Disease in Childhood

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Alvarado B

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Zunzunegui H

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Delisle and J

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Osorno

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Growth Trajectories Are Influenced by Breast Feeding and Infant Health in an Afro Colombian Community

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Journal of Nutrition

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nutrition0.175025014152344NN

Awasthi S

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Bundy

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Intestinal Nematode Infection and Anaemia in Developing Countries

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infection0.122222546933424NN
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British Medical Journal

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Awasthi S

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Bundy and L

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Savioli

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Helminthic Infections

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infection0.122222546933424NN

British Medical Journal

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Bairagi R

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Chowdhury Y

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Kim G

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Curlin and R

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Gray

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The Association between Malnutrition and Diarrhoea in Rural Bangladesh

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malnutrition0.0357189919948307NN
rural0.148975141598503JJ

Label: 1, with a score of: 0.349170025481151
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malnutrition0.0736315832425121NN
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International Journal of Epidemiology

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Banerjee I

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Ramani B

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Primrose P

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Moses M

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Iturriza Gomara J

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Gray S

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Jaffar M

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Bindhu J

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Muliyil D

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Brown M

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Estes and G

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Kang

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Comparative Study of the Epidemiology of Rotavirus in Children from Community Based Birth Cohort and Hospital in South India

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Journal of Clinical Microbiology

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Bang A

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Baitule M

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Reddy and M

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Deshmukh

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Effect of Home Based Neonatal Care and Management of Sepsis on Neonatal Mortality Field Trial in Rural India

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Lancet

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Baumgartner R

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Pollitt

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The Bacon Chow Study Analyses of the Effects of Infectious Illness on Growth of Infants

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Nutrition Research

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Becker S

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Black and K

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Brown

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Relative Effects of Diarrhea Fever and Dietary Energy Intake on Weight Gain in Rural Bangladeshi Children

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relative0JJ
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American Journal of Clinical Nutrition

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nutrition0.175025014152344NN

Behrman J

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Hoddinott J

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Maluccio E

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Soler Hampejsek E

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Behrman R

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Martorell M

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Ramirez Zea and D

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Stein

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What Determines Adult Cognitive Skills

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Impacts of Pre school Schooling and Post schooling Experiences in Guatemala

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PSC Working Paper Population Studies Center University of Pennsylvania Philadelphia

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Bennett J

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Boring

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Bundling Newly Identified Risk Factor for Neonatal Tetanus Implications for Global Control

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International Journal of Epidemiology

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Berg R

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Bridging the Great Divide Environmental Health and the Environmental Movement

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Journal of Environmental Health

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Berkman D

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Lescano R

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Gilman S

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Black

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Effects of Stunting Diarrhoeal Disease and Parasitic Infection during Infancy on Cognition in Late Childhood Follow up Study

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Lancet

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Bertozzi S

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Wegbreit L

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Feldman H

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Grant and M

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Isbell

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HIV AIDS Prevention and Treatment

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In Disease Control Priorities in Developing Countries nd ed

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ed

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Mills and P

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Musgrove

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Washington DC World Bank New York Oxford University Press

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Ensink and M

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Cameron

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Smoke and Malaria Are Interventions to Reduce Exposure to Indoor Air Pollution Likely to Increase Exposure REFERENCES to Mosquitoes

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Becker

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Blössner M

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de Onis

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Malnutrition Quantifying the Health Impact at National and Local Levels

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WHO Environmental Burden of Disease

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Boeston K

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Kolsky and C

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Hunt

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Improving Urban Water and Sanitation Services Health Access and Boundaries

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London Earthscan

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Mills

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Conquering the Intolerable Burden of Malaria What New What Needed Summary

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American Journal of Tropical Medical Hygiene Suppl

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Brenzel L

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Halsey

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Vaccine Preventable Diseases

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In Disease Control Priorities in Developing Countries nd ed

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ed

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Observations from Rural Bangladesh

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Lancet

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Briscoe J

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The Author Replies

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American Journal of Epidemiology

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Brown K

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Symposium Nutrition and Infection Prologue and Progress since Diarrhea and Malnutrition

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Journal of Nutrition S

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Bruce N

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Perez Padilla and R

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Albalak

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The Health Effects of Indoor Air Pollution Exposure in Developing Countries

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WHO SDE OEH

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World Health Organization Geneva

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Waterlow

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Effects of Early Disease on Later Growth and Early Growth on Later Disease in Khartoum Infants

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Annals of Human Biology

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Boschi Pinto K

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Shibuya and R

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Black

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Lancet

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Kerr

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Community Designed Built and Managed Toilet Blocks in Indian Cities

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Ingested Dose and Diarrhea Transmission Routes

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American Journal of Epidemiology

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Handwashing with Soap New Way to Prevent ARIs

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Kinnear

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American Journal of Epidemiology

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Valdmanis

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In Disease Control Priorities in Developing Countries nd

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Bulletin of the World Health Organization

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Cattand P

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Undernutrition as an Underlying Cause of Child Deaths Associated with Diarrhea Pneumonia Malaria and Measles

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Stunting Wasting and Micronutrient Deficiency Disorders

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In Disease Control Priorities in Developing Countries nd ed

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ed

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European Journal of Epidemiology

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Effects of Cryptosporidium parvum Infection in Peruvian Children Growth Faltering and Subsequent Catch up Growth

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American Journal of Epidemiology

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American Journal of Epidemiology

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Asymptomatic and Symptomatic Cryptosporidiosis Their Acute Effect on Weight Gain in Peruvian Children

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American Journal of Epidemiology

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Malek A

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Ahmed and M

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Salam

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Characteristics of Severely Malnourished Under Five Children Hospitalized with Diarrhoea and Their Policy Implications

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Acta Paediatrica

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Dewey

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Determinants of Growth from Birth to Months among Breast Fed Honduran Infants in Relation to Age of Introduction of Complementary Foods

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Pediatrics

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Lancet Infectious Diseases

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Demography

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Lancet

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Advances in Pediatrics

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In Principles of Public Health Practice ed

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Scutchfield and C

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Harnessing Local Governments and Communities to Improve Environmental Sanitation and Public Health in India

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Paper presented at the Workshop on Fiscal Decentralization and Local Governance in India organized by the Indian Institute of Public Administration in partnership with the government of Japan and the World Bank Goa India December

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Geneva World Health Organization

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WordScorePoS
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Dickson R

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Awasthi P

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Williamson C

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Demellweek and P

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Garner

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Effects of Treatment for Intestinal Helminth Infection on Growth and Cognitive Performance in Children Systematic Review of Randomised Trials

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British Medical Journal

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Eisenberg J

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Cevallos K

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Ponce K

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Levy S

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Bates J

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Scott A

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Hubbard N

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Vieira P

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Endara M

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Espinel G

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Trueba L

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Riley and J

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Trostle

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Environmental Change and Infectious Disease How New Roads Affect the Transmission of Diarrheal Pathogens in Rural Ecuador

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Proceedings of the National Academy of Sciences

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Porco

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Integrating Disease Control Strategies Balancing Water Sanitation and Hygiene Interventions to Reduce Diarrheal Disease Burden

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American Journal of Public Health

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Eriksson J

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The Fetal Origins Hypothesis Years On

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British Medical Journal

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Ezzati M

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Lopez A

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Rodgers and C

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Murray ed

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Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors

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Geneva World Health Organization

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Lopez S

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Mortality and Burden of Disease Attributable to Individual Risk Factors

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In Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors vol

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Geneva World Health Organization

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Potential Health Gains from Reducing Multiple Risk Factors

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In Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors vol

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Estimates of Global and Regional Potential Health Gains from Reducing Multiple Major Risk Factors

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The State of Food Insecurity in the World Eradicating World Hunger Taking Stock Ten Years after the World Food Summit

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Promoting Hygiene Behavior Change within IMCI The Peru and Nicaragua Experience

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Activity Report Environmental Health Project Office of Health Infectious Diseases and Nutrition Bureau for Global Health U

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Acta Tropica

Label: 0, with a score of: 1

Frenk J

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Bridging the Divide Global Lessons from Evidence Based Health Policy in Mexico

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Lancet

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Frias J

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Mukherjee

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Private Sector Sanitation Delivery in Vietnam Harnessing Market Power for Rural Sanitation

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Jakarta World Bank

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Galiani S

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Gertler and E

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Schargrodsky

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Water for Life The Impact of the Privatization of Water Services on Child Mortality

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water0.186896403054502NN
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Journal of Political Economy

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Ghana Statistical Service

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The Ghana Demographic and Health Survey

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Accra Ghana Statistical Service

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Jacoby

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An Economic Analysis of Delayed Primary School Enrollment in Low Income Country The Role of Early Childhood Nutrition

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Review of Economics and Statistics

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Jacoby and E

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King

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Early Childhood Nutrition and Academic Achievement Longitudinal Analysis

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Journal of Public Economics

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Shekar M

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Das Gupta C

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Bredenkamp and Y

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Lee

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India Malnourished Children Call for Reform and Action

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Washington DC World Bank

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Graham W

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Cairns S

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Bullough Z

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Quayyum and K

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Rogo

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Maternal and Perinatal Conditions

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In Disease Control Priorities in Developing Countries nd ed

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Jamison J

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Breman A

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Measham G

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Alleyne M

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Claeson D

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Evans P

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Jha A

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Mills and P

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Musgrove

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Washington DC World Bank New York Oxford University Press

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Richter and B

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Strupp

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Child Development in Developing Countries Developmental Potential in the First Years for Children in Developing Countries

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Lancet

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Griffiths M

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McGuire

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New Dimension for Health Reform The Integrated Community Child Health Program in Honduras

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In Health System Innovations in Central America Lessons and Impact of New Approaches ed

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La Forgia

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Washington DC World Bank

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Guerrant D

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Moore A

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Lima P

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Patrick J

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Schorling and R

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Guerrant

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Association of Early Childhood Diarrhea and Cryptosporidiosis with Impaired Physical Fitness and Cognitive Function Four Seven Years Later in Poor Urban Community in Northeast Brazil

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American Journal of Tropical Medicine and Hygiene

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Guerrant R

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Kirchhoff D

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Shields M

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Nations J

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Leslie M

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De Sousa J

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Araujo L

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Correia K

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Sauer K

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McClelland F

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Trowbridge and J

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Hughes

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Prospective Study of Diarrheal Illnesses in Northeastern Brazil Patterns of Disease Nutritional Impact Etiologies and Risk Factors

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Journal of Infectious Diseases

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disease0.215415047323213NN

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Guerrant R

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Lima and F

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Davidson

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Micronutrients and Infection Interactions and Implications with Enteric and Other Infections and Future Priorities

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Journal of Infectious Diseases Suppl

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disease0.215415047323213NN

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Guerrant R

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Schorling J

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McAuliffe and M

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Souza

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Diarrhea as Cause and Effect of Malnutrition Diarrhea Prevents Catch up Growth and Malnutrition Increases Diarrhea Frequency and Duration

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American Journal of Tropical Medicine and Hygiene

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Guyatt H

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Snow

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Impact of Malaria during Pregnancy on Low Birth Weight in Sub Saharan Africa

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Clinical Microbiology Reviews

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Ha D

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Huan

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Dengue Activity in Viet Nam and Its Control Programme

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Dengue Bulletin December

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december0.0548233071065585NNP

searo

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int en Section Section Section

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Habicht J

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DaVanzo and W

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Butz

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Mother Milk and Sewage Their Interactive Effects on Infant Mortality

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Pediatrics

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Dibley and K

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West

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Complex Interactions with Infection and Diet May Explain Seasonal Growth Responses to Vitamin in Preschool Aged Indonesian Children

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European Journal of Clinical Nutrition

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nutrition0.175025014152344NN

Hadi H

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Stoltzfus L

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Moulton M

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Dibley and K

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Respiratory Infections Reduce the Growth Response to Vitamin Supplementation in Randomized Controlled Trial

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International Journal of Epidemiology

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Harrison G

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Brush and F

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Zumrawi

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Motherhood and Infant Health in Khartoum

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Bulletin of the World Health Organization

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Heaver R

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Kachondam

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Thailand National Nutrition Program Lessons in Management and Capacity Development

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WHO SDE WSH

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Geneva World Health Organization

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int water sanitation health wsh en index

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American Journal Clinical Nutrition

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Parry O

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pdf

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Blumenthal

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Environmental Health Indicators and Sanitation Related Disease in Developing Countries Limitations to the Use of Routine Data Sources

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World Health Statistics Quarterly

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Working Note No

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October

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http www wds

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worldbank

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org external default WDSContentServer WDSP IB Rendered PDF Sanitation and hygiene at wb

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Kardjati

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Morbidity and Growth Performance of Infants in Madura Indonesia

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Annales Tropical Pediatrics

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Malaria Vaccines

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Frontiers in Bioscience May

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Bern and R

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Guerrant

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Bulletin of the World Health Organization

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Langhans W

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Ghana Cost of Environmental Damage An Analysis of Environmental Health

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Shahid Salles

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Intervention Cost Effectiveness Overview of Main Messages

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In Disease Control Priorities in Developing Countries nd ed

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Persistent Diarrhea Signals Critical Period of Increased Diarrhea Burdens and Nutritional Shortfalls Prospective Cohort Study among Children in Northeastern Brazil

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Journal of Infectious Diseases

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Environmental Health Bridging the Gaps

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Washington DC World Bank

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Early Childhood Diarrhea Predicts Impaired School Performance

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Pediatric Infectious Disease Journal

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Hoekstra

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Effect of Handwashing on Child Health Randomised Controlled Trial

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Lancet

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base0.0149758277542848NN
integrate0VB
malaria0.20370424488904NN
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social0JJ
forestry0NN
activity0NN
experience0.0249430985430622NN

Label: 1, with a score of: 0.467148552693629
WordScorePoS
community0NN
base0.0442083771593746NN
integrate0VB
malaria0NN
control0.0614198493690006NN
social0.112994637345193JJ
forestry0NN
activity0NN
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Indian Journal of Community Medicine

Label: 3, with a score of: 0.844743869197349
WordScorePoS
community0NN
medicine0.123094312756122NN

Label: 15, with a score of: 0.379357929923732
WordScorePoS
community0.016202004209163NN
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Maleta K

Label: 0, with a score of: 1

Virtanen M

Label: 0, with a score of: 1

Espo T

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Kulmala and P

Label: 0, with a score of: 1

Ashorn

Label: 0, with a score of: 1

Childhood Malnutrition and Its Predictors in Rural Malawi

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WordScorePoS
childhood0NN
malnutrition0.0357189919948307NN
rural0.148975141598503JJ

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malnutrition0NN
rural0JJ

Label: 1, with a score of: 0.325688472029987
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childhood0NN
malnutrition0.0736315832425121NN
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Paediatric and Perinatal Epidemiology

Label: 0, with a score of: 1

Maluccio J

Label: 0, with a score of: 1

Hoddinott and J

Label: 0, with a score of: 1

Behrman

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The Impact of an Experimental Nutrition Intervention in Childhood on Education among Guatemalan Adults

Label: 4, with a score of: 0.899871687926004
WordScorePoS
impact0NN
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adult0.163013873070017JJ

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WordScorePoS
impact0NN
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IFPRI and Food Consumption and Nutrition Division Discussion Paper International Food Policy Research Institute Washington DC

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WordScorePoS
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research0.0252000451111224NN

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WordScorePoS
food0.186896403054502NN
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food0NN
consumption0.147812295323721NN
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international0.00355521737836969JJ
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Marodi L

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Innate Cellular Immune Responses in Newborns

Label: 13, with a score of: 0.802638965065347
WordScorePoS
response0.0548233071065585NN
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Clinical Immunology

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Martorell R

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Results and Implications of the INCAP Follow up Study

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result0.0683326727248364NN
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Label: 15, with a score of: 0.603611645718736
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result0NN
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Journal of Nutrition Suppl

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WordScorePoS
nutrition0.175025014152344NN

Martorell R

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Habicht C

Label: 0, with a score of: 1

Yarbrough A

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Lechtig R

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Klein and K

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Western

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western0.0688661930304451JJ

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western0.0440683498519077JJ

Acute Morbidity and Physical Growth in Rural Guatemalan Children

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growth0.208565600657229NN
rural0JJ
child0.0452169560888236NN

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growth0.11178243319132NN
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American Journal of Disabled Children

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WordScorePoS
child0.10682408961305NN

Label: 4, with a score of: 0.439005712007529
WordScorePoS
child0.076326555629389NN

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child0.0603953832457135NN

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child0.0546336178945768NN

Martorell R

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Yarbrough A

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Lechtig J

Label: 0, with a score of: 1

Habicht and R

Label: 0, with a score of: 1

Klein

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Diarrheal Diseases and Growth Retardation in Preschool Guatemalan Children

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WordScorePoS
disease0.215415047323213NN
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Label: 8, with a score of: 0.528812615687779
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disease0NN
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American Journal of Physical Anthropology

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Mason J

Label: 0, with a score of: 1

Sanders P

Label: 0, with a score of: 1

Musgrove and R

Label: 0, with a score of: 1

Galloway

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Community Health and Nutrition Programs

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community0.0182713919265625NN
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Label: 3, with a score of: 0.639923903038982
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community0NN
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In Disease Control Priorities in Developing Countries nd ed

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disease0.215415047323213NN
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ed

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Jamison J

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Breman A

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Measham G

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Alleyne M

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Claeson D

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Evans P

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Jha A

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Mills and P

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Musgrove

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Washington DC World Bank New York Oxford University Press

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Mata L

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Diarrheal Disease as Cause of Malnutrition

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American Journal of Tropical Medicine and Hygiene Suppl

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WordScorePoS
tropical0JJ
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Mathee A

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Swanepoel and A

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Swart

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Environmental Health Services

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environmental0.0537696560159885JJ
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Label: 12, with a score of: 0.332070614168503
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In The South African Health Review ed

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Crisp and A

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Ntuli

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Durban South Africa Health Systems Trust

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healthlink

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za uploads files chapter

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pdf

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Mavalankar D

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Manjunath

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Sanitation and Water Supply The Forgotten Infrastructure

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sanitation0.0737171311497939NN
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WordScorePoS
sanitation0NN
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In India Infrastructure Report Ensuring Value for Money ed

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infrastructure0.192202909044225NN
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Morris

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New Delhi Oxford University Press

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university0.0815069365350084NN

Menendez C

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Fleming and P

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Alonso

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Malaria Related Anaemia

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Parasitology Today

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Modi V

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McDade D

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Lallement and J

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Saghir

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Energy Services for the Millennium Development Goals

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Paper prepared for the Millennium Project of the United Nations Development Programme and World Bank Washington DC

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Molbak K

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Andersen P

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Aaby N

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Hojlyng M

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Jakobsen M

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Sodeman and A

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Silva

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Cryptosporidium Infection in Infancy as Cause of Malnutrition Community Study from Guinea Bissau West Africa

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American Journal Clinical Nutrition

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Moore S

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Lima M

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Conaway J

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Schorling A

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Soares and R

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Guerrant

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Early Childhood Diarrhoea and Helminthiases Associate with Long Term Linear Growth Faltering

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International Journal of Epidemiology

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Morley D

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environmental0JJ
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Bicknell and M

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Woodland

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Factors Influencing the Growth and Nutritional Status of Infants and Young Children in Nigerian Village

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Transactions of the Royal Society of Tropical Medicine and Hygiene

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Moser Jones M

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Protecting Public Health in New York City Years of Leadership

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New York New York City Department of Health and Mental Hygiene

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Moy R

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Choto A

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McNeish and I

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Booth

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Diarrhoea and Growth Faltering in Rural Zimbabwe

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European Journal of Clinical Nutrition

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Mullany L

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Darmstadt S

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LeClerg S

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Shrestra R

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Adhikari and J

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Tielsch

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Topical Applications of Chlorhexidine to the Umbilical Cord for Prevention of Omphalitis and Neonatal Mortality in Southern Nepal CommunityBased Cluster Randomized Trial

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Lancet

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Murphy H

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Stanton and J

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Galbraith

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Prevention Environmental Health Interventions to Sustain Child Survival

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Washington DC U

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Agency for International Development

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Murray C

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Laakso K

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Shibuya T

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Laakso K

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Hill and A

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Lopez

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Can We Achieve Millennium Development Goal

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New Analysis of Country Trends and Forecasts of under Mortality to

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Lancet

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Lew Yasukawa A

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Long Wagar A

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Arvin and D

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Griffin

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AgeDependent Differences in IgG Isotype and Avidity Induced by Measles Vaccine Received during the First Year of Life

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Journal of Infectious Diseases

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National Center for Infectious Diseases

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Malaria Vector Control

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Centers for Disease Control and Prevention Atlanta

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cdc

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gov malaria control prevention vector control

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Detection and Characterization of Diarrheagenic Escherichia coli from Young Children in Hanoi Vietnam

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Journal of Clinical Microbiology

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Early Childhood Diarrhea Is Associated with Diminished Cognitive Function to Years Later in Children in Northeast Brazilian Shantytown

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American Journal of Tropical Medicine and Hygiene

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International Journal of Cancer

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Oriá V

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Madhavan R

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Limitations in Verbal Fluency Following Heavy Burdens of Early Childhood Diarrhea in Brazilian Shantytown Children

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The Relationship between Child Anthropometry and Mortality in Developing Countries Implications for Policy Programs and Future Research

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Changes in Child Survival Are Strongly Associated with Changes in Malnutrition in Developing Countries

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Methodology for Estimating the Contribution of Malnutrition to Child Mortality in Developing Countries

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REFERENCES PIDE Pakistan Institute of Development Economics Micronutrient Laboratories Aga Khan University Medical Centre

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Poverty Environment Partnership

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Poverty Health and Environment Placing Environmental Health on Countries Development Agendas

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Joint agency paper World Bank Washington DC

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Powanda M

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Metabolic Effects of Infection on Protein and Energy Status

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Journal of Nutrition Suppl

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Prado M

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Cairncross M

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Barreto A

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Oliviera Assis and S

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Rego

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Asymptomatic Giardiasis and Growth in Young Children Longitudinal Study in Salvador Brazil

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Parasitology

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Prüss Üstün A

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Corvalán

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Preventing Disease through Healthy Environments Towards an Estimate of the Environmental Burden of Disease

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Returns to Investment in Education Further Update

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Public Private Partnership for Handwashing with Soap

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globalhandwashing

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org Country act Peru

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Quddus A

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Luby M

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Rahbar and Y

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Pervaiz

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International Journal of Epidemiology

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Curtis

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Handwashing and Risk of Respiratory Infections Quantitative Systematic Review

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American Journal of Clinical Nutrition

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nutrition0.175025014152344NN

Sachdev H

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Fall C

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Osmond R

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Lakshmy S

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Biswas S

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Leary K

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Reddy D

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Barker and S

Label: 0, with a score of: 1

Bhargava

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Anthropometric Indicators of Body ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Composition in Young Adults Relation to Size at Birth and Serial Measurements of Body Mass Index in Childhood in the New Delhi Birth Cohort

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American Journal of Clinical Nutrition

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Sarraf M

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Larsen and M

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Owaygen

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Cost of Environmental Degradation The Case of Lebanon and Tunisia

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Environment Department Paper World Bank Washington DC

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Albrecht D

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Reynolds S

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Stagno and F

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Ennis

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Transfer of Measles Mumps and Rubella Antibodies from Mother to Infant Its Effect on Measles Mumps and Rubella Immunization

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American Journal of Diseases of Children

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child0.10682408961305NN

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In Pursuit of Healthy Urban Environment in Low and MiddleIncome Nations

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In Scaling Urban Environmental Challenges From Local to Global and Back ed

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London Earthscan

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Mcauliffe M

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De Souza and R

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Guerrant

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Malnutrition Is Associated with Increased Diarrhoea Incidence and Duration among Children in an Urban Brazilian Slum

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International Journal of Epidemiology

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Scrimshaw N

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Historical Concepts of Interactions Synergism and Antagonism between Nutrition and Infection

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Journal of Nutrition Suppl

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Scrimshaw N

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Taylor and J

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Gordon

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American Journal of Medical Sciences

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Sedgwick W

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Macnutt

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An Examination of the Theorem of Allen Hazen That for Every Death from Typhoid Fever Avoided by the Purification of Public Water Supplies Two or Three Deaths Are Avoided from Other Causes

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Valdespino

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Improvement of Child Survival in Mexico The Diagonal Approach

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Repositioning Nutrition as Central to Development Strategy for Large Scale Action

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de Onis R

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Costa Lima M

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Blössner and G

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Clugston

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The Worldwide Timing of Growth Faltering Implications for Nutritional Interventions

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Pediatrics

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Hennessy L

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Bulkow L

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Hammitt T

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Rudolph and A

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Invasive Pneumococcal Disease Caused by Nonvaccine Serotypes among Alaska Native Children with High Levels of Valent Pneumococcal Conjugate Vaccine Coverage

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Journal of the American Medical Association

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An Assessment of Programs to Promote Improved Household Stoves in China

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Energy for Sustainable Development

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How Much Global Ill Health Is Attributable to Environmental Factors

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Indoor Air Pollution from Household Use of Solid Fuels

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In Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors vol

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ed

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Murray

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Incomes in Ghana Policy Discussion Paper

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UNICEF United Nations Children Fund

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Global Database on Low Birthweight

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UNICEF New York

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UNICEF New York

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Molbak

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Community Based Controlled Trial of Dietary Management of Children with Persistent Diarrhea Sustained Beneficial Effect on Ponderal and Linear Growth

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American Journal of Clinical Nutrition

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Briscoe

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Drinking Water Quality Sanitation and BreastFeeding Their Interactive Effects on Infant Health

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Bulletin of the World Health Organization

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Erhart and U

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D Alessandro

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The Contribution of Malaria in Pregnancy to Perinatal Mortality

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American Journal of Tropical Medicine and Hygiene Suppl

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ENVIRONMENTAL HEALTH AND CHILD SURVIVAL Vergnano S

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Heath

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Neonatal Sepsis An International Perspective

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Archives of Disease in Childhood Fetal and Neonatal Edition

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Pneumonia Diarrhea and Growth in the First Years of Life Longitudinal Study of Urban Brazilian Children

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American Journal Clinical Nutrition

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Victora C

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Co coverage of Preventive Interventions and Implications for Child Survival Strategies Evidence from National Surveys

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Lancet

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Villamor E

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Bosch R

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Mbise and W

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Fawzi

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Human Immunodeficiency Virus Infection Diarrheal Disease and Sociodemographic Predictors of Child Growth

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Acta Paediatrica

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von Schirnding Y

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Short Report The World Summit on Sustainable Development Reaffirming the Centrality of Health

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Globalization and Health

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Kay

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Elimination of Dengue by Community Programs Using Mesocyclops Copepoda against Aedis Aegypti in Central Vietnam

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American Journal of Tropical Medicine and Hygiene

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Wagstaff A

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The Millennium Development Goals for Health Rising to the Challenges

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Washington DC World Bank

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Effects of Early Childhood Psychosocial Stimulation and Nutritional Supplementation on Cognition and Education in Growth Stunted Jamaican Children Prospective Cohort Study

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Child Development Risk Factors for Adverse Outcomes in Developing Countries

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Bulletin of the World Health Organization

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West K

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WHO World Health Organization

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Geneva WHO

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The World Health Report Reducing Risks Promoting Healthy Life

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Geneva WHO

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int whr en index

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Insecticide Treated Mosquito Net Interventions Manual for National Control Programme Managers

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World Health Report

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Geneva WHO

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Fuel for Life Household Energy and Health

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Geneva WHO

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Burden of Disease Project

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WHO and UNICEF World Health Organization and United Nations Children Fund

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Immunologic Basis for Increased Susceptibility of the Neonate to Infection

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Repositioning Nutrition as Central to Development Strategy for Large Scale Action

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health0.0229054731708393NN

New York Oxford University Press

Label: 4, with a score of: 1
WordScorePoS
university0.0815069365350084NN

World Water Forum

Label: 6, with a score of: 0.931535066795248
WordScorePoS
world0.00438651305628668NN
water0.556409482163189NN
forum0NN

Label: 12, with a score of: 0.31816584975757
WordScorePoS
world0.00464349782489754NN
water0.186896403054502NN
forum0NN

Water Infrastructures for Sustainable and Equitable Development

Label: 6, with a score of: 0.819981294389916
WordScorePoS
water0.556409482163189NN
infrastructure0.0181797964452808NN
sustainable0.00146217101876223JJ
equitable0.0502364757923669JJ
development0NN

Label: 9, with a score of: 0.385009663802852
WordScorePoS
water0.0377086395700813NN
infrastructure0.192202909044225NN
sustainable0.00901749491165909JJ
equitable0.0221298700466866JJ
development0.0330049940546426NN

Label: 12, with a score of: 0.332977733444608
WordScorePoS
water0.186896403054502NN
infrastructure0.028867295332595NN
sustainable0.0162522423871414JJ
equitable0JJ
development0.022306853314744NN

Framework Theme

Label: 8, with a score of: 0.582311626793575
WordScorePoS
framework0.0428212738652355NN

Label: 1, with a score of: 0.435111236119743
WordScorePoS
framework0.0319966432858631NN

Label: 13, with a score of: 0.39669042038544
WordScorePoS
framework0.0291713033871158NN

Label: 12, with a score of: 0.392556320467174
WordScorePoS
framework0.028867295332595NN

Fourth World Water Forum Mexico City March

Label: 11, with a score of: 0.738546428726613
WordScorePoS
world0.00626002771693937NN
water0.0458109463416786NN
forum0NN
city0.607697021770652NN

Label: 6, with a score of: 0.62775685109271
WordScorePoS
world0.00438651305628668NN
water0.556409482163189NN
forum0NN
city0NN

Label: 12, with a score of: 0.21441038463123
WordScorePoS
world0.00464349782489754NN
water0.186896403054502NN
forum0NN
city0NN

worldwatercouncil

Label: 0, with a score of: 1

id

Label: 0, with a score of: 1

WSP Water and Sanitation Program

Label: 6, with a score of: 0.967174522313024
WordScorePoS
water0.556409482163189NN
sanitation0.334686906581616NN

Label: 12, with a score of: 0.202852846930375
WordScorePoS
water0.186896403054502NN
sanitation0NN

Lessons Learned from Bangladesh India and Pakistan Scaling Up Rural Sanitation in South Asia

Label: 6, with a score of: 0.708718998751769
WordScorePoS
learn0VB
scale0NN
rural0JJ
sanitation0.334686906581616NN
south0RB
asia0IN

Label: 4, with a score of: 0.517787042006634
WordScorePoS
learn0.244520809605025VB
scale0NN
rural0JJ
sanitation0NN
south0RB
asia0IN

Label: 2, with a score of: 0.39110057448176
WordScorePoS
learn0VB
scale0.0357189919948307NN
rural0.148975141598503JJ
sanitation0NN
south0RB
asia0IN

New Delhi WSP World Bank

Label: 2, with a score of: 0.918499615257701
WordScorePoS
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 17, with a score of: 0.375629786620639
WordScorePoS
world0.00418824502414673NN
bank0.036961556179878NN

The Mumbai Slum Sanitation Program Partnering with Slum Communities for Sustainable Sanitation in Megalopolis

Label: 6, with a score of: 0.888486458917198
WordScorePoS
slum0NN
sanitation0.334686906581616NN
community0.0214003646985842NN
sustainable0.00146217101876223JJ

Label: 11, with a score of: 0.38553736114165
WordScorePoS
slum0.146277152173395NN
sanitation0NN
community0NN
sustainable0.00782503464617421JJ

New Delhi WSP World Bank

Label: 2, with a score of: 0.918499615257701
WordScorePoS
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 17, with a score of: 0.375629786620639
WordScorePoS
world0.00418824502414673NN
bank0.036961556179878NN

From Burden to Communal Responsibility Sanitation Success Story from Southern Region in Ethiopia

Label: 6, with a score of: 0.647012000213964
WordScorePoS
burden0NN
responsibility0NN
sanitation0.334686906581616NN
southern0JJ
region0NN

Label: 1, with a score of: 0.474943940878509
WordScorePoS
burden0NN
responsibility0NN
sanitation0NN
southern0.0614198493690006JJ
region0.184259548107002NN

Label: 3, with a score of: 0.369999322320418
WordScorePoS
burden0NN
responsibility0NN
sanitation0.0249430985430622NN
southern0.0416126148005059JJ
region0.124837844401518NN

Label: 5, with a score of: 0.356273534523
WordScorePoS
burden0NN
responsibility0.0911713013253052NN
sanitation0NN
southern0.0465610847355851JJ
region0.0465610847355851NN

New Delhi WSP World Bank

Label: 2, with a score of: 0.918499615257701
WordScorePoS
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 17, with a score of: 0.375629786620639
WordScorePoS
world0.00418824502414673NN
bank0.036961556179878NN

Yacoob M

Label: 0, with a score of: 1

Kelly

Label: 0, with a score of: 1

Secondary Cities in West Africa The Challenge for Environmental Health and Prevention

Label: 11, with a score of: 0.902529777458142
WordScorePoS
secondary0JJ
city0.607697021770652NN
africa0IN
challenge0.0947742174515357NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
prevention0NN

Label: 3, with a score of: 0.328635737030278
WordScorePoS
secondary0JJ
city0NN
africa0IN
challenge0NN
environmental0JJ
health0.191387734041787NN
prevention0.0923207345670913NN

Comparative Urban Studies Occasional Paper Woodrow Wilson International Center for Scholars Washington DC

Label: 11, with a score of: 0.959812200394372
WordScorePoS
urban0.27622591898666JJ
study0NN
international0JJ

Zaracostas J

Label: 0, with a score of: 1

Mortality from Measles Fell by in Africa and by Worldwide from to

Label: 3, with a score of: 0.989039760718619
WordScorePoS
mortality0.276962203701274NN
measles0.0407408489778079NNS
fall0.123094312756122NN
africa0IN
worldwide0RB

British Medical Journal

Label: 0, with a score of: 1

Zhang J

Label: 0, with a score of: 1

Smith

Label: 0, with a score of: 1

Indoor Air Pollution from Household Fuel Combustion in China Review

Label: 5, with a score of: 0.586389979023241
WordScorePoS
air0NN
pollution0NN
household0.0465610847355851NN
fuel0.0558185411034276NN
review0.0688661930304451NN

Label: 12, with a score of: 0.573475477860162
WordScorePoS
air0.0554128417527413NN
pollution0.0234335422829798NN
household0.0554128417527413NN
fuel0.0332151194779746NN
review0NN

Label: 14, with a score of: 0.329083594105433
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN
household0NN
fuel0NN
review0NN

Presentation at Indoor Air Beijing September

Label: 5, with a score of: 0.771946410450677
WordScorePoS
air0NN
beij0.0911713013253052NN

Label: 12, with a score of: 0.469179924626428
WordScorePoS
air0.0554128417527413NN
beij0NN

Zumrawi F

Label: 0, with a score of: 1

Dimond and J

Label: 0, with a score of: 1

Waterlow

Label: 0, with a score of: 1

Effects of Infection on Growth in Sudanese Children

Label: 8, with a score of: 0.604229898255283
WordScorePoS
effect0NN
infection0NN
growth0.208565600657229NN
child0.0452169560888236NN

Label: 3, with a score of: 0.545336242453721
WordScorePoS
effect0NN
infection0.122222546933424NN
growth0NN
child0.10682408961305NN

Label: 10, with a score of: 0.323841937601795
WordScorePoS
effect0NN
infection0NN
growth0.11178243319132NN
child0.0242343960710022NN

Human Nutrition and Clinical Nutrition

Label: 2, with a score of: 0.987621839605039
WordScorePoS
human0JJ
nutrition0.175025014152344NN

N E Boxes figures notes and tables are indicated by and respectively

Label: 9, with a score of: 1
WordScorePoS
figure0.0602029956716497NN

acute lower respiratory infection ALRI health systems and immunity indoor air pollution and malnutrition and micronutrient supplementation and multiplier effect on prevention of Adair L

Label: 3, with a score of: 0.789048546840427
WordScorePoS
infection0.122222546933424NN
health0.191387734041787NN
system0NN
air0.020806307400253NN
pollution0.0175975629039954NN
malnutrition0NN
effect0NN
prevention0.0923207345670913NN

advocacy AF

Label: 0, with a score of: 1

See attributable fractions Afghanistan malnutrition in Africa See also specific regions and countries environmental health interventions in malnutrition in trypanosomiasis in AIDS

Label: 3, with a score of: 0.720784908841564
WordScorePoS
malnutrition0NN
africa0IN
specific0JJ
region0.124837844401518NN
country0NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
aid0.123094312756122NN

Label: 1, with a score of: 0.564139655779787
WordScorePoS
malnutrition0.0736315832425121NN
africa0IN
specific0JJ
region0.184259548107002NN
country0NN
environmental0.0442083771593746JJ
health0NN
intervention0NN
aid0NN

See HIV AIDS air pollution

Label: 3, with a score of: 0.965077128802644
WordScorePoS
hiv0.448149338755887NN
aid0.123094312756122NN
air0.020806307400253NN
pollution0.0175975629039954NN

See indoor air pollution outdoor air pollution Alderman H

Label: 14, with a score of: 0.605812469342387
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN

Label: 12, with a score of: 0.497027388029788
WordScorePoS
air0.0554128417527413NN
pollution0.0234335422829798NN

Algeria and budget increases for environmental protection Alilio M

Label: 1, with a score of: 0.731267030257039
WordScorePoS
increase0NN
environmental0.0442083771593746JJ
protection0.122839698738001NN

Label: 10, with a score of: 0.405901870853166
WordScorePoS
increase0.00285817158600878NN
environmental0.0237821918091848JJ
protection0.0660824365173543NN

Label: 12, with a score of: 0.303864832301405
WordScorePoS
increase0.00958677785775002NN
environmental0.0598270388037045JJ
protection0NN

ALRI

Label: 0, with a score of: 1

See acute lower respiratory infection Alternative Energy Promotion Center Nepal American Academy of Pediatrics anemia antibiotics Argentina privatization of public water companies in ARI

Label: 6, with a score of: 0.599084254630757
WordScorePoS
infection0NN
alternative0NN
energy0.0153390539205676NN
promotion0NN
public0NN
water0.556409482163189NN
company0NN

Label: 7, with a score of: 0.518265174618212
WordScorePoS
infection0NN
alternative0NN
energy0.494617163780726NN
promotion0NN
public0NN
water0NN
company0NN

Label: 12, with a score of: 0.480136869055609
WordScorePoS
infection0NN
alternative0NN
energy0.133960988253756NN
promotion0NN
public0.028867295332595NN
water0.186896403054502NN
company0.108503934593034NN

See acute lower respiratory infection Asia See also specific countries birth weight in burden of disease in education in environmental health interventions in immunization in infrastructure budgets in malaria in malnutrition in vector control programs in attributable fractions AF burden of disease when multiple risk factors present and of child mortality Cox hazard model and malnutrition attributable fractions for different diseases Bangladesh case control study in indoor air pollution malnutrition in mortality in nutritional status and infectious disease in oral rehydration therapy in Total Sanitation Campaign vector control measures in weight gain retardation in Barker hypothesis See also fetal programming bednets

Label: 3, with a score of: 0.835067938050245
WordScorePoS
infection0.122222546933424NN
asia0IN
specific0JJ
country0NN
birth0.0748292956291867NN
burden0NN
disease0.215415047323213NN
education0.0152605842304358NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
infrastructure0NN
malaria0.20370424488904NN
malnutrition0NN
control0.020806307400253NN
multiple0JJ
risk0.0703902516159815NN
child0.10682408961305NN
mortality0.276962203701274NN
hazard0NN
study0NN
air0.020806307400253NN
pollution0.0175975629039954NN
nutritional0JJ
status0NN
therapy0.0407408489778079NN
total0NN
sanitation0.0249430985430622NN
measure0NN
gain0NN

Label: 6, with a score of: 0.363265608079476
WordScorePoS
infection0NN
asia0IN
specific0JJ
country0NN
birth0NN
burden0NN
disease0.103230094596636NN
education0NN
environmental0JJ
health0NN
intervention0NN
infrastructure0.0181797964452808NN
malaria0NN
malnutrition0.041835863322702NN
control0NN
multiple0JJ
risk0NN
child0.0255958462813622NN
mortality0NN
hazard0NN
study0NN
air0NN
pollution0.0590310971343993NN
nutritional0JJ
status0NN
therapy0NN
total0.0295155485671997NN
sanitation0.334686906581616NN
measure0NN
gain0.041835863322702NN

Label: 9, with a score of: 0.129837319988221
WordScorePoS
infection0NN
asia0IN
specific0JJ
country0NN
birth0NN
burden0NN
disease0NN
education0.022550656390892NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
intervention0NN
infrastructure0.192202909044225NN
malaria0NN
malnutrition0NN
control0NN
multiple0JJ
risk0NN
child0NN
mortality0NN
hazard0NN
study0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
therapy0NN
total0.0260040237236563NN
sanitation0.0737171311497939NN
measure0NN
gain0NN

Label: 4, with a score of: 0.111196039747459
WordScorePoS
infection0NN
asia0IN
specific0JJ
country0NN
birth0NN
burden0NN
disease0NN
education0.244244978014045NN
environmental0JJ
health0NN
intervention0NN
infrastructure0NN
malaria0NN
malnutrition0NN
control0NN
multiple0JJ
risk0NN
child0.076326555629389NN
mortality0NN
hazard0NN
study0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
therapy0NN
total0NN
sanitation0NN
measure0NN
gain0NN

See insecticide treated nets Behrman J

Label: 0, with a score of: 1

Beisel W

Label: 0, with a score of: 1

bias statistical biomass See also fuels birth weight See also underweight Blössner M

Label: 0, with a score of: 1

INDEX Bolivia indoor air pollution in Brazil growth stunting in helminth infections in malnutrition and educational outcomes in nutritional status and infectious disease in public participation in health programs in school enrollment and performance in vector control measures in breastfeeding Breman J

Label: 3, with a score of: 0.570363559957549
WordScorePoS
air0.020806307400253NN
pollution0.0175975629039954NN
growth0NN
stunt0NN
infection0.122222546933424NN
malnutrition0NN
educational0JJ
outcome0NN
nutritional0JJ
status0NN
disease0.215415047323213NN
public0.021678073222951NN
participation0NN
health0.191387734041787NN
school0NN
performance0NN
control0.020806307400253NN
measure0NN

Label: 4, with a score of: 0.23355771887443
WordScorePoS
air0NN
pollution0NN
growth0NN
stunt0NN
infection0NN
malnutrition0NN
educational0JJ
outcome0.0416255041156371NN
nutritional0JJ
status0NN
disease0NN
public0NN
participation0NN
health0NN
school0.208127520578185NN
performance0NN
control0NN
measure0NN

Label: 8, with a score of: 0.227547955888465
WordScorePoS
air0NN
pollution0NN
growth0.208565600657229NN
stunt0NN
infection0NN
malnutrition0NN
educational0JJ
outcome0NN
nutritional0JJ
status0NN
disease0NN
public0NN
participation0NN
health0NN
school0NN
performance0NN
control0NN
measure0.0347609334428716NN

Label: 5, with a score of: 0.339161205916085
WordScorePoS
air0NN
pollution0NN
growth0NN
stunt0NN
infection0NN
malnutrition0NN
educational0JJ
outcome0.0465610847355851NN
nutritional0JJ
status0NN
disease0NN
public0.0727679293221751NN
participation0.0465610847355851NN
health0.0571058915334038NN
school0.0931221694711702NN
performance0NN
control0.0465610847355851NN
measure0NN

Label: 1, with a score of: 0.32946843530885
WordScorePoS
air0NN
pollution0NN
growth0.0519476926891779NN
stunt0NN
infection0NN
malnutrition0.0736315832425121NN
educational0JJ
outcome0NN
nutritional0JJ
status0NN
disease0NN
public0NN
participation0.0614198493690006NN
health0NN
school0NN
performance0NN
control0.0614198493690006NN
measure0.103895385378356NN

Briend A

Label: 0, with a score of: 1

burden of disease areas for further research environmental burdens environmental health burdens estimates of country level environmental health computation of methodological aspects of monetary values from water sanitation and hygiene malnutrition infection link multiplier effect of interventions Cairncross S

Label: 6, with a score of: 0.687941387606966
WordScorePoS
burden0NN
disease0.103230094596636NN
research0NN
environmental0JJ
health0NN
estimate0NN
country0NN
level0.00647010760354177NN
aspect0NN
value0NN
water0.556409482163189NN
sanitation0.334686906581616NN
hygiene0.136665345449673NN
malnutrition0.041835863322702NN
infection0NN
effect0NN
intervention0NN

Label: 3, with a score of: 0.5440592303351
WordScorePoS
burden0NN
disease0.215415047323213NN
research0.0175975629039954NN
environmental0JJ
health0.191387734041787NN
estimate0.059903311017139NN
country0NN
level0NN
aspect0.0307735781890304NN
value0NN
water0.0382775468083574NN
sanitation0.0249430985430622NN
hygiene0NN
malnutrition0NN
infection0.122222546933424NN
effect0NN
intervention0.0407408489778079NN

Label: 12, with a score of: 0.268001338282698
WordScorePoS
burden0NN
disease0NN
research0NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
estimate0.0199423462679015NN
country0NN
level0.00513687014008325NN
aspect0NN
value0NN
water0.186896403054502NN
sanitation0NN
hygiene0NN
malnutrition0NN
infection0NN
effect0NN
intervention0NN

Carson Rachel Central America See also specific countries growth and height indicators in nutrition programs in Chatterjee N

Label: 2, with a score of: 0.615559608880232
WordScorePoS
central0.0440683498519077JJ
specific0JJ
country0NN
growth0.0252000451111224NN
height0NN
nutrition0.175025014152344NN

Label: 8, with a score of: 0.52553427467133
WordScorePoS
central0JJ
specific0JJ
country0NN
growth0.208565600657229NN
height0NN
nutrition0NN

Label: 1, with a score of: 0.433937021428432
WordScorePoS
central0JJ
specific0JJ
country0NN
growth0.0519476926891779NN
height0.120266261535276NN
nutrition0NN

childbirth child survival strategies environmental management programs health systems childbirth and infant care programs immunization programs micronutrient supplementation programs infrastructure strategies fuel supply sanitation water supply China cost of environmental health risks in National Improved Stove Program NISP nutritional status and infectious disease in water related deaths in rural areas of citizen mobilization Clean Water Program Mexico climate change related diseases cognition See also school performance childhood growth and diarrhea and environmental impacts on malnutrition and valuations of Colombia cost benefit analysis in cost of environmental health risks in nutritional status and infectious disease in Community Based Poverty Reduction Project Ghana community empowerment Comparative Risk Assessment WHO cookstoves See also fuels coordination

Label: 6, with a score of: 0.594085667676181
WordScorePoS
childbirth0NN
child0.0255958462813622NN
strategy0NN
environmental0JJ
management0.0428007293971684NN
health0NN
system0NN
infant0NN
care0NN
infrastructure0.0181797964452808NN
fuel0NN
supply0.0590310971343993NN
sanitation0.334686906581616NN
water0.556409482163189NN
cost0NN
risk0NN
national0JJ
improve0.0511916925627245VB
nutritional0JJ
status0NN
disease0.103230094596636NN
related0.0524959536790166JJ
death0.0295155485671997NN
rural0JJ
mobilization0NN
clean0.0348974218717993JJ
climate0NN
change0NN
school0NN
performance0NN
childhood0NN
growth0NN
impact0.0181797964452808NN
malnutrition0.041835863322702NN
benefit0NN
community0.0214003646985842NN
base0NN
poverty0NN
reduction0NN
project0.041835863322702NN
empowerment0NN
coordination0NN

Label: 3, with a score of: 0.451308896004696
WordScorePoS
childbirth0.0407408489778079NN
child0.10682408961305NN
strategy0.0149758277542848NN
environmental0JJ
management0.0127591822694525NN
health0.191387734041787NN
system0NN
infant0NN
care0.104031537001265NN
infrastructure0NN
fuel0NN
supply0NN
sanitation0.0249430985430622NN
water0.0382775468083574NN
cost0NN
risk0.0703902516159815NN
national0.00558382296134999JJ
improve0VB
nutritional0JJ
status0NN
disease0.215415047323213NN
related0.0125195145191824JJ
death0.193573191943949NN
rural0JJ
mobilization0NN
clean0.020806307400253JJ
climate0NN
change0NN
school0NN
performance0NN
childhood0NN
growth0NN
impact0NN
malnutrition0NN
benefit0NN
community0NN
base0.0149758277542848NN
poverty0.00914534810831654NN
reduction0.0149758277542848NN
project0NN
empowerment0NN
coordination0NN

Label: 12, with a score of: 0.312778748065766
WordScorePoS
childbirth0NN
child0NN
strategy0NN
environmental0.0598270388037045JJ
management0.0339811641917276NN
health0.0339811641917276NN
system0NN
infant0NN
care0NN
infrastructure0.028867295332595NN
fuel0.0332151194779746NN
supply0.0703006268489394NN
sanitation0NN
water0.186896403054502NN
cost0.0277064208763707NN
risk0NN
national0.00743561777158133JJ
improve0VB
nutritional0JJ
status0NN
disease0NN
related0.00833571598658786JJ
death0NN
rural0JJ
mobilization0NN
clean0JJ
climate0NN
change0NN
school0NN
performance0NN
childhood0NN
growth0NN
impact0.0866018859977851NN
malnutrition0NN
benefit0NN
community0.0169905820958638NN
base0.0199423462679015NN
poverty0.0121782716594324NN
reduction0.0199423462679015NN
project0.0664302389559493NN
empowerment0NN
coordination0NN

Label: 1, with a score of: 0.234831882664522
WordScorePoS
childbirth0NN
child0.0450489732120807NN
strategy0.0442083771593746NN
environmental0.0442083771593746JJ
management0NN
health0NN
system0.0519476926891779NN
infant0NN
care0NN
infrastructure0NN
fuel0NN
supply0NN
sanitation0NN
water0NN
cost0NN
risk0.0519476926891779NN
national0.0164833460638534JJ
improve0VB
nutritional0JJ
status0NN
disease0NN
related0.0184786920895884JJ
death0NN
rural0JJ
mobilization0.0908430554521382NN
clean0JJ
climate0.0376648791150643NN
change0NN
school0NN
performance0NN
childhood0NN
growth0.0519476926891779NN
impact0NN
malnutrition0.0736315832425121NN
benefit0NN
community0NN
base0.0442083771593746NN
poverty0.269969049497485NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

Label: 13, with a score of: 0.221987584790004
WordScorePoS
childbirth0NN
child0NN
strategy0.0201523636533764NN
environmental0JJ
management0.0171695137813101NN
health0NN
system0NN
infant0NN
care0NN
infrastructure0NN
fuel0NN
supply0NN
sanitation0NN
water0NN
cost0.0279982034978914NN
risk0NN
national0.0112708859309299JJ
improve0.0102677744436108VB
nutritional0JJ
status0NN
disease0NN
related0.0168470026160727JJ
death0NN
rural0JJ
mobilization0NN
clean0JJ
climate0.291881734282273NN
change0.402565546215053NN
school0NN
performance0NN
childhood0NN
growth0NN
impact0.0437569550806737NN
malnutrition0NN
benefit0NN
community0.0343390275626203NN
base0NN
poverty0NN
reduction0.0403047273067529NN
project0.0335649154577099NN
empowerment0NN
coordination0NN

Label: 2, with a score of: 0.186483382877183
WordScorePoS
childbirth0NN
child0.0546336178945768NN
strategy0NN
environmental0JJ
management0NN
health0NN
system0.0756001353333673NN
infant0.0583416713841148NN
care0NN
infrastructure0.0155217067874935NN
fuel0NN
supply0NN
sanitation0NN
water0NN
cost0NN
risk0.0252000451111224NN
national0.00399807039435538JJ
improve0.0218534471578307VB
nutritional0.0583416713841148JJ
status0NN
disease0NN
related0.00896409157262106JJ
death0.0252000451111224NN
rural0.148975141598503JJ
mobilization0NN
clean0JJ
climate0.0365427838531249NN
change0.0756001353333673NN
school0.0297950283197006NN
performance0NN
childhood0NN
growth0.0252000451111224NN
impact0NN
malnutrition0.0357189919948307NN
benefit0.0252000451111224NN
community0.0182713919265625NN
base0NN
poverty0.0261926252110933NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

Label: 5, with a score of: 0.172224570141853
WordScorePoS
childbirth0NN
child0.0170753354211044NN
strategy0NN
environmental0JJ
management0NN
health0.0571058915334038NN
system0NN
infant0NN
care0.0931221694711702NN
infrastructure0.024255976440725NN
fuel0.0558185411034276NN
supply0NN
sanitation0NN
water0NN
cost0NN
risk0NN
national0.0124956749436837JJ
improve0VB
nutritional0JJ
status0NN
disease0NN
related0JJ
death0NN
rural0JJ
mobilization0NN
clean0JJ
climate0NN
change0NN
school0.0931221694711702NN
performance0NN
childhood0NN
growth0NN
impact0NN
malnutrition0NN
benefit0.0393804437159645NN
community0NN
base0NN
poverty0NN
reduction0NN
project0NN
empowerment0.273513903975916NN
coordination0NN

Label: 9, with a score of: 0.158754650671955
WordScorePoS
childbirth0NN
child0NN
strategy0NN
environmental0.0221298700466866JJ
management0NN
health0.0377086395700813NN
system0NN
infant0NN
care0.030745604615229NN
infrastructure0.192202909044225NN
fuel0NN
supply0NN
sanitation0.0737171311497939NN
water0.0377086395700813NN
cost0NN
risk0NN
national0.00412562425683033JJ
improve0VB
nutritional0JJ
status0NN
disease0NN
related0.00925008066007716JJ
death0NN
rural0JJ
mobilization0NN
clean0.030745604615229JJ
climate0NN
change0NN
school0NN
performance0NN
childhood0NN
growth0.0260040237236563NN
impact0.0160169090870187NN
malnutrition0NN
benefit0.0260040237236563NN
community0.0188543197850406NN
base0NN
poverty0NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

Label: 7, with a score of: 0.142056771006293
WordScorePoS
childbirth0NN
child0NN
strategy0NN
environmental0JJ
management0NN
health0NN
system0NN
infant0NN
care0NN
infrastructure0.0651354046449052NN
fuel0.0749457204978913NN
supply0.0528748274225028NN
sanitation0NN
water0NN
cost0NN
risk0NN
national0JJ
improve0.0229264916384433VB
nutritional0JJ
status0NN
disease0NN
related0JJ
death0NN
rural0JJ
mobilization0NN
clean0.125032076213024JJ
climate0.115011305411453NN
change0.105749654845006NN
school0NN
performance0NN
childhood0NN
growth0NN
impact0NN
malnutrition0NN
benefit0NN
community0NN
base0NN
poverty0NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

Label: 8, with a score of: 0.113080115656856
WordScorePoS
childbirth0NN
child0.0452169560888236NN
strategy0.0295821503613099NN
environmental0.0295821503613099JJ
management0NN
health0NN
system0NN
infant0NN
care0NN
infrastructure0NN
fuel0NN
supply0NN
sanitation0NN
water0NN
cost0NN
risk0NN
national0.0055149369084567JJ
improve0.0150723186962745VB
nutritional0JJ
status0NN
disease0NN
related0.0123650647908625JJ
death0NN
rural0JJ
mobilization0NN
clean0JJ
climate0NN
change0NN
school0NN
performance0NN
childhood0NN
growth0.208565600657229NN
impact0NN
malnutrition0NN
benefit0NN
community0NN
base0NN
poverty0.0722601961736204NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

Label: 4, with a score of: 0.104772199164549
WordScorePoS
childbirth0NN
child0.076326555629389NN
strategy0NN
environmental0JJ
management0NN
health0NN
system0NN
infant0NN
care0.0416255041156371NN
infrastructure0NN
fuel0NN
supply0.0352060273355634NN
sanitation0NN
water0NN
cost0NN
risk0NN
national0JJ
improve0.0305306222517556VB
nutritional0JJ
status0NN
disease0NN
related0JJ
death0NN
rural0JJ
mobilization0NN
clean0JJ
climate0NN
change0NN
school0.208127520578185NN
performance0NN
childhood0.0815069365350084NN
growth0NN
impact0NN
malnutrition0NN
benefit0NN
community0NN
base0NN
poverty0NN
reduction0NN
project0NN
empowerment0NN
coordination0NN

See intersectoral and interjurisdictional coordination Corvalán C

Label: 17, with a score of: 1
WordScorePoS
coordination0.0978661089756501NN

Costa Rica targeted environmental health programs in cost benefit analysis Cox hazard model DALYs

Label: 3, with a score of: 0.549058863848696
WordScorePoS
target0NN
environmental0JJ
health0.191387734041787NN
cost0NN
benefit0NN
hazard0NN

Label: 10, with a score of: 0.374063223046747
WordScorePoS
target0NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
cost0.0660824365173543NN
benefit0NN
hazard0NN

See disability adjusted life years Dandoy S

Label: 4, with a score of: 0.57850142010723
WordScorePoS
disability0.0704120546711269NN
life0.0125233923809486NN

Label: 11, with a score of: 0.519106372162599
WordScorePoS
disability0.0631828116343571NN
life0.0112376090361851NN

Label: 10, with a score of: 0.389859213658161
WordScorePoS
disability0.0558912165956601NN
life0NN

Label: 8, with a score of: 0.328718996173829
WordScorePoS
disability0.0347609334428716NN
life0.0123650647908625NN

Daniels M

Label: 0, with a score of: 1

Das Gupta M

Label: 0, with a score of: 1

death rates

Label: 3, with a score of: 0.856547921137624
WordScorePoS
death0.193573191943949NN
rate0.0433561464459019NN

Label: 16, with a score of: 0.374625532797261
WordScorePoS
death0.0464294830712827NN
rate0.0571955184484387NN

See mortality dehydration See also oral rehydration therapy Demographic and Health Surveys DHSs dengue virus de Onis M

Label: 3, with a score of: 0.946079606484935
WordScorePoS
mortality0.276962203701274NN
therapy0.0407408489778079NN
health0.191387734041787NN
survey0NN

Desai M

Label: 0, with a score of: 1

INDEX developing countries See also specific countries environmental health experiences in health agendas in infectious disease studies in infrastructure programs in integrated child survival programs in nutrition programs in vector control programs in devolution of authority deworming See also helminth infections DHS

Label: 3, with a score of: 0.804502918897057
WordScorePoS
develop0VB
country0NN
specific0JJ
environmental0JJ
health0.191387734041787NN
experience0.0249430985430622NN
agenda0NN
disease0.215415047323213NN
study0NN
infrastructure0NN
integrate0VB
child0.10682408961305NN
nutrition0NN
control0.020806307400253NN
infection0.122222546933424NN

Label: 9, with a score of: 0.267019881908774
WordScorePoS
develop0VB
country0NN
specific0JJ
environmental0.0221298700466866JJ
health0.0377086395700813NN
experience0NN
agenda0NN
disease0NN
study0NN
infrastructure0.192202909044225NN
integrate0VB
child0NN
nutrition0NN
control0NN
infection0NN

Label: 2, with a score of: 0.225946546901841
WordScorePoS
develop0VB
country0NN
specific0JJ
environmental0JJ
health0NN
experience0NN
agenda0NN
disease0NN
study0NN
infrastructure0.0155217067874935NN
integrate0VB
child0.0546336178945768NN
nutrition0.175025014152344NN
control0NN
infection0NN

See Demographic and Health Surveys diarrhea antibiotics for treating burden of disease cognition and dehydration and food restriction and growth faltering and health systems and household prevention of in infancy infections and malnutrition and micronutrient supplementation and mortality and transmission routes underweight and disability adjusted life years DALYs diseases

Label: 3, with a score of: 0.817072697012713
WordScorePoS
health0.191387734041787NN
survey0NN
burden0NN
disease0.215415047323213NN
food0NN
restriction0NN
growth0NN
system0NN
household0NN
prevention0.0923207345670913NN
infection0.122222546933424NN
malnutrition0NN
mortality0.276962203701274NN
disability0NN
life0.0250390290383647NN

Label: 2, with a score of: 0.34464690896847
WordScorePoS
health0NN
survey0NN
burden0.0440683498519077NN
disease0NN
food0.292342270824999NN
restriction0.0583416713841148NN
growth0.0252000451111224NN
system0.0756001353333673NN
household0.0297950283197006NN
prevention0NN
infection0NN
malnutrition0.0357189919948307NN
mortality0NN
disability0NN
life0NN

Label: 12, with a score of: 0.231124348220368
WordScorePoS
health0.0339811641917276NN
survey0NN
burden0NN
disease0NN
food0.186896403054502NN
restriction0NN
growth0NN
system0NN
household0.0554128417527413NN
prevention0.0409791940864438NN
infection0NN
malnutrition0NN
mortality0NN
disability0NN
life0.0250071479597636NN

Label: 8, with a score of: 0.157063949344131
WordScorePoS
health0NN
survey0NN
burden0NN
disease0NN
food0NN
restriction0NN
growth0.208565600657229NN
system0NN
household0NN
prevention0NN
infection0NN
malnutrition0NN
mortality0NN
disability0.0347609334428716NN
life0.0123650647908625NN

See specific diseases by name drug resistance dysentery early infancy economic costs cost benefit analysis country level costs of environmental health burden environmental health valuations See also environmental health valuations Ecuador nutrition programs in education malnutrition and school performance stunting and valuation of Egypt cost of environmental health risks in nutritional status and infectious disease in El Salvador indoor air pollution in empowerment energy and energy supplies

Label: 3, with a score of: 0.528651351521182
WordScorePoS
specific0JJ
disease0.215415047323213NN
drug0.0407408489778079NN
economic0JJ
cost0NN
benefit0NN
country0NN
level0NN
environmental0JJ
health0.191387734041787NN
burden0NN
nutrition0NN
education0.0152605842304358NN
malnutrition0NN
school0NN
performance0NN
stunt0NN
risk0.0703902516159815NN
nutritional0JJ
status0NN
air0.020806307400253NN
pollution0.0175975629039954NN
empowerment0NN
energy0NN
supplies0NNS

Label: 7, with a score of: 0.384197075998466
WordScorePoS
specific0JJ
disease0NN
drug0NN
economic0JJ
cost0NN
benefit0NN
country0NN
level0NN
environmental0JJ
health0NN
burden0NN
nutrition0NN
education0NN
malnutrition0NN
school0NN
performance0NN
stunt0NN
risk0NN
nutritional0JJ
status0NN
air0NN
pollution0NN
empowerment0NN
energy0.494617163780726NN
supplies0NNS

Label: 12, with a score of: 0.367280515771698
WordScorePoS
specific0.0542519672965169JJ
disease0NN
drug0NN
economic0.0433009429988926JJ
cost0.0277064208763707NN
benefit0NN
country0NN
level0.00513687014008325NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
burden0NN
nutrition0NN
education0.0101607690729067NN
malnutrition0NN
school0NN
performance0NN
stunt0NN
risk0NN
nutritional0JJ
status0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
empowerment0NN
energy0.133960988253756NN
supplies0NNS

Label: 5, with a score of: 0.301264683013859
WordScorePoS
specific0JJ
disease0NN
drug0NN
economic0.0727679293221751JJ
cost0NN
benefit0.0393804437159645NN
country0NN
level0.0172651853471334NN
environmental0JJ
health0.0571058915334038NN
burden0NN
nutrition0NN
education0.0512260062633133NN
malnutrition0NN
school0.0931221694711702NN
performance0NN
stunt0NN
risk0NN
nutritional0JJ
status0NN
air0NN
pollution0NN
empowerment0.273513903975916NN
energy0NN
supplies0NNS

Label: 2, with a score of: 0.21040360227259
WordScorePoS
specific0JJ
disease0NN
drug0NN
economic0JJ
cost0NN
benefit0.0252000451111224NN
country0NN
level0.00552410547653725NN
environmental0JJ
health0NN
burden0.0440683498519077NN
nutrition0.175025014152344NN
education0NN
malnutrition0.0357189919948307NN
school0.0297950283197006NN
performance0NN
stunt0.11668334276823NN
risk0.0252000451111224NN
nutritional0.0583416713841148JJ
status0NN
air0NN
pollution0NN
empowerment0NN
energy0.0130963126055467NN
supplies0NNS

Label: 4, with a score of: 0.184683577980134
WordScorePoS
specific0JJ
disease0NN
drug0NN
economic0JJ
cost0NN
benefit0NN
country0NN
level0.0231525547935232NN
environmental0JJ
health0NN
burden0NN
nutrition0NN
education0.244244978014045NN
malnutrition0NN
school0.208127520578185NN
performance0NN
stunt0NN
risk0NN
nutritional0JJ
status0NN
air0NN
pollution0NN
empowerment0NN
energy0NN
supplies0NNS

Label: 8, with a score of: 0.104661986940661
WordScorePoS
specific0JJ
disease0NN
drug0NN
economic0.128463821595706JJ
cost0NN
benefit0NN
country0NN
level0.00761994916892276NN
environmental0.0295821503613099JJ
health0NN
burden0NN
nutrition0NN
education0.0150723186962745NN
malnutrition0NN
school0NN
performance0NN
stunt0NN
risk0NN
nutritional0JJ
status0NN
air0NN
pollution0NN
empowerment0NN
energy0NN
supplies0NNS

See fuels environmental health defined environmental health approaches critical moments in decline in agenda for developing country experiences enabling environment governance and institutional implications history institutional requirements environmental health valuations cognition and current practices education and malnutrition and new estimates for next steps environmental management programs epidemiology Eritrea Integrated Early Childhood Development Project Ethiopia environmental health institutions in environmental health policies in political commitment in sanitation in Europe developing countries compared to malaria in Expanded Program on Immunization fecal pollution fetal programming See also Barker hypothesis fetuses See also pregnancy Fewtrell L

Label: 3, with a score of: 0.542048816615085
WordScorePoS
fuel0NN
environmental0JJ
health0.191387734041787NN
approach0NN
critical0JJ
decline0.0351951258079907NN
agenda0NN
develop0VB
country0NN
experience0.0249430985430622NN
enable0VB
environment0NN
governance0NN
institutional0JJ
history0NN
current0JJ
practice0NN
education0.0152605842304358NN
malnutrition0NN
estimate0.059903311017139NN
management0.0127591822694525NN
integrate0VB
childhood0NN
development0.00837573444202498NN
project0NN
institution0NN
policy0NN
political0JJ
commitment0NN
sanitation0.0249430985430622NN
compare0.0307735781890304VB
malaria0.20370424488904NN
expand0VB
pollution0.0175975629039954NN

Label: 6, with a score of: 0.222382434688223
WordScorePoS
fuel0NN
environmental0JJ
health0NN
approach0NN
critical0JJ
decline0NN
agenda0NN
develop0VB
country0NN
experience0NN
enable0VB
environment0NN
governance0NN
institutional0JJ
history0NN
current0JJ
practice0NN
education0NN
malnutrition0.041835863322702NN
estimate0NN
management0.0428007293971684NN
integrate0.0251182378961834VB
childhood0NN
development0NN
project0.041835863322702NN
institution0NN
policy0NN
political0JJ
commitment0NN
sanitation0.334686906581616NN
compare0VB
malaria0NN
expand0.0251182378961834VB
pollution0.0590310971343993NN

Label: 16, with a score of: 0.210620116728344
WordScorePoS
fuel0NN
environmental0JJ
health0NN
approach0NN
critical0JJ
decline0NN
agenda0.0811931365363091NN
develop0VB
country0NN
experience0NN
enable0VB
environment0NN
governance0.107490825192354NN
institutional0JJ
history0NN
current0JJ
practice0NN
education0.0201317944152378NN
malnutrition0NN
estimate0NN
management0NN
integrate0VB
childhood0NN
development0.0368309542451156NN
project0NN
institution0.274477239401321NN
policy0.0201317944152378NN
political0JJ
commitment0NN
sanitation0NN
compare0VB
malaria0NN
expand0VB
pollution0NN

Label: 4, with a score of: 0.172923992838055
WordScorePoS
fuel0NN
environmental0JJ
health0NN
approach0NN
critical0JJ
decline0NN
agenda0NN
develop0VB
country0NN
experience0NN
enable0VB
environment0.0299609328954485NN
governance0NN
institutional0JJ
history0NN
current0JJ
practice0NN
education0.244244978014045NN
malnutrition0NN
estimate0.0299609328954485NN
management0NN
integrate0VB
childhood0.0815069365350084NN
development0.0279277626235394NN
project0NN
institution0NN
policy0NN
political0JJ
commitment0NN
sanitation0NN
compare0VB
malaria0NN
expand0.0299609328954485VB
pollution0NN

Fishman S

Label: 0, with a score of: 1

INDEX food restriction and diarrhea food security fuels See also biomass cookstoves indoor air pollution and infrastructure improvements and Gambia growth retardation in nutritional status and infectious disease in GDP

Label: 2, with a score of: 0.692435265228797
WordScorePoS
food0.292342270824999NN
restriction0.0583416713841148NN
security0.0893850849591018NN
fuel0NN
air0NN
pollution0NN
infrastructure0.0155217067874935NN
improvement0NN
growth0.0252000451111224NN
nutritional0.0583416713841148JJ
status0NN
disease0NN
gdp0NN

Label: 12, with a score of: 0.428649701459688
WordScorePoS
food0.186896403054502NN
restriction0NN
security0NN
fuel0.0332151194779746NN
air0.0554128417527413NN
pollution0.0234335422829798NN
infrastructure0.028867295332595NN
improvement0NN
growth0NN
nutritional0JJ
status0NN
disease0NN
gdp0NN

Label: 9, with a score of: 0.250991366242237
WordScorePoS
food0.0188543197850406NN
restriction0NN
security0NN
fuel0NN
air0NN
pollution0NN
infrastructure0.192202909044225NN
improvement0.0454743001434393NN
growth0.0260040237236563NN
nutritional0JJ
status0NN
disease0NN
gdp0NN

Label: 3, with a score of: 0.211375240942688
WordScorePoS
food0NN
restriction0NN
security0NN
fuel0NN
air0.020806307400253NN
pollution0.0175975629039954NN
infrastructure0NN
improvement0NN
growth0NN
nutritional0JJ
status0NN
disease0.215415047323213NN
gdp0NN

Label: 8, with a score of: 0.173689197414293
WordScorePoS
food0NN
restriction0NN
security0NN
fuel0NN
air0NN
pollution0NN
infrastructure0NN
improvement0NN
growth0.208565600657229NN
nutritional0JJ
status0NN
disease0NN
gdp0NN

Label: 7, with a score of: 0.309573976999
WordScorePoS
food0.0383371018038178NN
restriction0NN
security0.0625160381065121NN
fuel0.0749457204978913NN
air0NN
pollution0NN
infrastructure0.0651354046449052NN
improvement0.0924643738905717NN
growth0NN
nutritional0JJ
status0NN
disease0NN
gdp0NN

See gross domestic product Ghana ALRI in basic indicators for childhood weight in Community Based Poverty Reduction Project cost of environmental health risks in Demographic and Health Survey diarrhea in environmental health valuations in fuels in GDP in height for age rates in hygiene in indoor air pollution in malaria in malnutrition in mortality in nn nutritional programs in school enrollment and education in water in Ghana Demographic and Health Survey Glewwe P

Label: 3, with a score of: 0.614319768654533
WordScorePoS
gross0JJ
domestic0JJ
product0NN
basic0JJ
childhood0NN
community0NN
base0.0149758277542848NN
poverty0.00914534810831654NN
reduction0.0149758277542848NN
project0NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
survey0NN
fuel0NN
gdp0NN
height0NN
age0.0893142758861673NN
rate0.0433561464459019NN
hygiene0NN
air0.020806307400253NN
pollution0.0175975629039954NN
malaria0.20370424488904NN
malnutrition0NN
mortality0.276962203701274NN
nutritional0JJ
school0NN
education0.0152605842304358NN
water0.0382775468083574NN

Label: 1, with a score of: 0.354502339801991
WordScorePoS
gross0JJ
domestic0JJ
product0NN
basic0.0639932865717261JJ
childhood0NN
community0NN
base0.0442083771593746NN
poverty0.269969049497485NN
reduction0NN
project0NN
cost0NN
environmental0.0442083771593746JJ
health0NN
risk0.0519476926891779NN
survey0NN
fuel0NN
gdp0NN
height0.120266261535276NN
age0.112994637345193NN
rate0.0639932865717261NN
hygiene0NN
air0NN
pollution0NN
malaria0NN
malnutrition0.0736315832425121NN
mortality0NN
nutritional0JJ
school0NN
education0.0225244866060403NN
water0NN

Label: 6, with a score of: 0.340279568734204
WordScorePoS
gross0JJ
domestic0JJ
product0NN
basic0.0181797964452808JJ
childhood0NN
community0.0214003646985842NN
base0NN
poverty0NN
reduction0NN
project0.041835863322702NN
cost0NN
environmental0JJ
health0NN
risk0NN
survey0NN
fuel0NN
gdp0NN
height0NN
age0NN
rate0NN
hygiene0.136665345449673NN
air0NN
pollution0.0590310971343993NN
malaria0NN
malnutrition0.041835863322702NN
mortality0NN
nutritional0JJ
school0NN
education0NN
water0.556409482163189NN

Label: 12, with a score of: 0.296316236380889
WordScorePoS
gross0JJ
domestic0JJ
product0.0199423462679015NN
basic0.0144336476662975JJ
childhood0NN
community0.0169905820958638NN
base0.0199423462679015NN
poverty0.0121782716594324NN
reduction0.0199423462679015NN
project0.0664302389559493NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
survey0NN
fuel0.0332151194779746NN
gdp0NN
height0NN
age0NN
rate0NN
hygiene0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
malaria0NN
malnutrition0NN
mortality0NN
nutritional0JJ
school0NN
education0.0101607690729067NN
water0.186896403054502NN

Label: 4, with a score of: 0.242747593549137
WordScorePoS
gross0JJ
domestic0JJ
product0NN
basic0.0433695758119029JJ
childhood0.0815069365350084NN
community0NN
base0NN
poverty0NN
reduction0NN
project0NN
cost0NN
environmental0JJ
health0NN
risk0NN
survey0NN
fuel0NN
gdp0NN
height0NN
age0.0255262687343935NN
rate0.0216847879059514NN
hygiene0NN
air0NN
pollution0NN
malaria0NN
malnutrition0NN
mortality0NN
nutritional0JJ
school0.208127520578185NN
education0.244244978014045NN
water0NN

Global Burden of Disease Project Global Public Private Partnership for Handwashing with Soap Gordon J

Label: 17, with a score of: 0.825551718839412
WordScorePoS
global0.0201198688839505JJ
burden0.036961556179878NN
disease0NN
project0NN
public0.0390556786919513NN
private0.0898760357768464JJ
partnership0.3914644359026NN

Label: 3, with a score of: 0.366101475983257
WordScorePoS
global0.013959557403375JJ
burden0NN
disease0.215415047323213NN
project0NN
public0.021678073222951NN
private0JJ
partnership0NN

Grantham McGregor S

Label: 0, with a score of: 1

gross domestic product GDP burden of disease and diarrheal infections and health costs and malnutrition effect on growth faltering

Label: 3, with a score of: 0.658615565134426
WordScorePoS
gross0JJ
domestic0JJ
product0NN
gdp0NN
burden0NN
disease0.215415047323213NN
infection0.122222546933424NN
health0.191387734041787NN
cost0NN
malnutrition0NN
effect0NN
growth0NN

Label: 8, with a score of: 0.471032023403553
WordScorePoS
gross0.0410992516792148JJ
domestic0.0695218668857431JJ
product0.0591643007226199NN
gdp0NN
burden0NN
disease0NN
infection0NN
health0NN
cost0NN
malnutrition0NN
effect0NN
growth0.208565600657229NN

See linear growth and growth faltering See also IUGR Guatemala cost of environmental health risks in indoor air pollution in nutritional status and infectious disease in school performance in strength of association study in handwashing

Label: 3, with a score of: 0.523058321733194
WordScorePoS
growth0NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
air0.020806307400253NN
pollution0.0175975629039954NN
nutritional0JJ
status0NN
disease0.215415047323213NN
school0NN
performance0NN
study0NN

Label: 8, with a score of: 0.453177927436228
WordScorePoS
growth0.208565600657229NN
cost0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
disease0NN
school0NN
performance0NN
study0NN

Label: 4, with a score of: 0.2111394209827
WordScorePoS
growth0NN
cost0NN
environmental0JJ
health0NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
disease0NN
school0.208127520578185NN
performance0NN
study0NN

Label: 10, with a score of: 0.474287005073046
WordScorePoS
growth0.11178243319132NN
cost0.0660824365173543NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0.0488696285210061NN
disease0NN
school0NN
performance0.064698038783335NN
study0NN

See hygiene Hartge P

Label: 6, with a score of: 1
WordScorePoS
hygiene0.136665345449673NN

health inspectors health ministries and departments advocacy role of in developing countries environmental health and health programs and public health personnel technical and policy inputs health systems height and growth of children

Label: 3, with a score of: 0.758277605314584
WordScorePoS
health0.191387734041787NN
develop0VB
country0NN
environmental0JJ
public0.021678073222951NN
technical0JJ
policy0NN
input0NN
system0NN
height0NN
growth0NN
child0.10682408961305NN

Label: 8, with a score of: 0.219544554443842
WordScorePoS
health0NN
develop0VB
country0NN
environmental0.0295821503613099JJ
public0NN
technical0.0410992516792148JJ
policy0.0452169560888236NN
input0NN
system0NN
height0NN
growth0.208565600657229NN
child0.0452169560888236NN

See linear growth and growth faltering helminth infections See also hookworms cognitive functions and deworming See also deworming drug resistance and growth faltering and health systems and Hill Austin Bradford HIV AIDS Hoddinott J

Label: 3, with a score of: 0.737228165280401
WordScorePoS
growth0NN
infection0.122222546933424NN
function0NN
drug0.0407408489778079NN
health0.191387734041787NN
system0NN
hiv0.448149338755887NN
aid0.123094312756122NN

Label: 8, with a score of: 0.54677904706287
WordScorePoS
growth0.208565600657229NN
infection0NN
function0NN
drug0NN
health0NN
system0NN
hiv0NN
aid0.0607878664258118NN

Honduras Integrated Community Based Child Care Program nutritional status and infectious disease in hookworms See also helminth infections deworming of environmental risk factors and malnutrition and during pregnancy sanitation and vaccines against human capital approach hygiene burden of disease child delivery and INDEX child survival programs and diarrhea and environmental risk factors and infrastructure improvements and maternal and childhood underweight miasma theory and pathogen transmission and private sector involvement in related diseases water quantities and IAP

Label: 3, with a score of: 0.651528380002822
WordScorePoS
integrate0VB
community0NN
base0.0149758277542848NN
child0.10682408961305NN
care0.104031537001265NN
nutritional0JJ
status0NN
disease0.215415047323213NN
infection0.122222546933424NN
environmental0JJ
risk0.0703902516159815NN
malnutrition0NN
sanitation0.0249430985430622NN
vaccine0.162963395911232NN
human0JJ
approach0NN
hygiene0NN
burden0NN
infrastructure0NN
improvement0NN
maternal0.184641469134183JJ
childhood0NN
private0JJ
sector0NN
related0.0125195145191824JJ
water0.0382775468083574NN

Label: 6, with a score of: 0.591009032793827
WordScorePoS
integrate0.0251182378961834VB
community0.0214003646985842NN
base0NN
child0.0255958462813622NN
care0NN
nutritional0JJ
status0NN
disease0.103230094596636NN
infection0NN
environmental0JJ
risk0NN
malnutrition0.041835863322702NN
sanitation0.334686906581616NN
vaccine0NN
human0.0127979231406811JJ
approach0NN
hygiene0.136665345449673NN
burden0NN
infrastructure0.0181797964452808NN
improvement0NN
maternal0JJ
childhood0NN
private0JJ
sector0.0214003646985842NN
related0.0524959536790166JJ
water0.556409482163189NN

Label: 9, with a score of: 0.204755913478293
WordScorePoS
integrate0VB
community0.0188543197850406NN
base0NN
child0NN
care0.030745604615229NN
nutritional0JJ
status0NN
disease0NN
infection0NN
environmental0.0221298700466866JJ
risk0NN
malnutrition0NN
sanitation0.0737171311497939NN
vaccine0NN
human0.011275328195446JJ
approach0NN
hygiene0NN
burden0NN
infrastructure0.192202909044225NN
improvement0.0454743001434393NN
maternal0JJ
childhood0NN
private0.0368585655748969JJ
sector0.0565629593551219NN
related0.00925008066007716JJ
water0.0377086395700813NN

Label: 12, with a score of: 0.177226113128385
WordScorePoS
integrate0.0199423462679015VB
community0.0169905820958638NN
base0.0199423462679015NN
child0NN
care0NN
nutritional0JJ
status0NN
disease0NN
infection0NN
environmental0.0598270388037045JJ
risk0NN
malnutrition0NN
sanitation0NN
vaccine0NN
human0.0101607690729067JJ
approach0.0542519672965169NN
hygiene0NN
burden0NN
infrastructure0.028867295332595NN
improvement0NN
maternal0JJ
childhood0NN
private0JJ
sector0.0169905820958638NN
related0.00833571598658786JJ
water0.186896403054502NN

See indoor air pollution IMCI

Label: 14, with a score of: 0.605812469342387
WordScorePoS
air0.0271683202880942NN
pollution0.0689352823740101NN

Label: 12, with a score of: 0.497027388029788
WordScorePoS
air0.0554128417527413NN
pollution0.0234335422829798NN

Label: 11, with a score of: 0.434600238273636
WordScorePoS
air0.0373517915079663NN
pollution0.0315914058171786NN

Label: 6, with a score of: 0.372116900223995
WordScorePoS
air0NN
pollution0.0590310971343993NN

See Integrated Management of Childhood Illness immunity immunizations See also vaccinations income losses India birth weight in environmental health functions in indoor air pollution in Integrated Child Development Services malaria in malnutrition in nutritional programs in oral rehydration therapy in sanitation in Indonesia indoor air pollution IAP ALRI and burden of disease clinical studies of cookstoves and environmental risk factors of malaria and mortality pregnancy and related diseases indoor residual spraying infant care programs infants and young children See also specific diseases and interventions breastfeeding

Label: 3, with a score of: 0.796628818164324
WordScorePoS
integrate0VB
management0.0127591822694525NN
childhood0NN
illness0.0407408489778079NN
income0NN
loss0NN
birth0.0748292956291867NN
environmental0JJ
health0.191387734041787NN
function0NN
air0.020806307400253NN
pollution0.0175975629039954NN
child0.10682408961305NN
development0.00837573444202498NN
service0.0100171139310145NN
malaria0.20370424488904NN
malnutrition0NN
nutritional0JJ
therapy0.0407408489778079NN
sanitation0.0249430985430622NN
burden0NN
disease0.215415047323213NN
study0NN
risk0.0703902516159815NN
mortality0.276962203701274NN
related0.0125195145191824JJ
infant0NN
care0.104031537001265NN
specific0JJ
intervention0.0407408489778079NN

Label: 6, with a score of: 0.356981418517641
WordScorePoS
integrate0.0251182378961834VB
management0.0428007293971684NN
childhood0NN
illness0NN
income0NN
loss0NN
birth0NN
environmental0JJ
health0NN
function0NN
air0NN
pollution0.0590310971343993NN
child0.0255958462813622NN
development0NN
service0.0084006124696649NN
malaria0NN
malnutrition0.041835863322702NN
nutritional0JJ
therapy0NN
sanitation0.334686906581616NN
burden0NN
disease0.103230094596636NN
study0NN
risk0NN
mortality0NN
related0.0524959536790166JJ
infant0NN
care0NN
specific0JJ
intervention0NN

Label: 10, with a score of: 0.147546084175854
WordScorePoS
integrate0VB
management0NN
childhood0NN
illness0NN
income0.166475342664294NN
loss0NN
birth0.0396106020715138NN
environmental0.0237821918091848JJ
health0.0405241466500776NN
function0NN
air0NN
pollution0NN
child0.0242343960710022NN
development0.0177346522508396NN
service0.00795378154685591NN
malaria0NN
malnutrition0NN
nutritional0JJ
therapy0NN
sanitation0NN
burden0NN
disease0NN
study0NN
risk0NN
mortality0.0488696285210061NN
related0JJ
infant0NN
care0NN
specific0JJ
intervention0NN

See breastfeeding burden of disease cognition and diarrhea and environmental health risks and infections in linear growth in malnutrition and infections diarrhea and in early infancy growth faltering and malnutrition and micronutrient supplementation and during pregnancy primary prevention of infrastructure child survival strategies and developing countries programs public health agenda and insecticide treated nets ITNs institutional capacity Integrated Child Development Services India Integrated Community Based Child Care Program Honduras Integrated Early Childhood Development Project Eritrea Integrated Management of Childhood Illness IMCI intersectoral and interjurisdictional coordination interventions burdens of disease and childhood growth and costs and benefits of customizing of by health ministries in history of environmental health multiplier effect for environmental health intrauterine growth restriction IUGR invisible regulator ITNs

Label: 3, with a score of: 0.656584461138739
WordScorePoS
burden0NN
disease0.215415047323213NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
infection0.122222546933424NN
growth0NN
malnutrition0NN
primary0.0108390366114755JJ
prevention0.0923207345670913NN
infrastructure0NN
child0.10682408961305NN
strategy0.0149758277542848NN
develop0VB
country0NN
public0.021678073222951NN
agenda0NN
institutional0JJ
capacity0.00625975725959118NN
integrate0VB
development0.00837573444202498NN
service0.0100171139310145NN
community0NN
base0.0149758277542848NN
care0.104031537001265NN
childhood0NN
project0NN
management0.0127591822694525NN
illness0.0407408489778079NN
coordination0NN
intervention0.0407408489778079NN
cost0NN
benefit0NN
history0NN
effect0NN
restriction0NN

Label: 8, with a score of: 0.340602450914963
WordScorePoS
burden0NN
disease0NN
environmental0.0295821503613099JJ
health0NN
risk0NN
infection0NN
growth0.208565600657229NN
malnutrition0NN
primary0JJ
prevention0NN
infrastructure0NN
child0.0452169560888236NN
strategy0.0295821503613099NN
develop0VB
country0NN
public0NN
agenda0NN
institutional0JJ
capacity0.0123650647908625NN
integrate0.0295821503613099VB
development0.0055149369084567NN
service0.0197870712294258NN
community0NN
base0NN
care0NN
childhood0NN
project0NN
management0NN
illness0NN
coordination0NN
intervention0NN
cost0NN
benefit0NN
history0NN
effect0NN
restriction0NN

Label: 9, with a score of: 0.213961473703115
WordScorePoS
burden0NN
disease0NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
risk0NN
infection0NN
growth0.0260040237236563NN
malnutrition0NN
primary0.0160169090870187JJ
prevention0NN
infrastructure0.192202909044225NN
child0NN
strategy0NN
develop0VB
country0NN
public0.0160169090870187NN
agenda0NN
institutional0JJ
capacity0NN
integrate0VB
development0.0330049940546426NN
service0.0148023490369527NN
community0.0188543197850406NN
base0NN
care0.030745604615229NN
childhood0NN
project0NN
management0NN
illness0NN
coordination0NN
intervention0NN
cost0NN
benefit0.0260040237236563NN
history0NN
effect0.0454743001434393NN
restriction0NN

See insecticide treated nets IUGR intrauterine growth restriction Jacoby H

Label: 8, with a score of: 0.80970305123265
WordScorePoS
growth0.208565600657229NN
restriction0NN

Label: 10, with a score of: 0.433966948259953
WordScorePoS
growth0.11178243319132NN
restriction0NN

Label: 2, with a score of: 0.324329527679769
WordScorePoS
growth0.0252000451111224NN
restriction0.0583416713841148NN

Jamaica correlation between education deficiency and stunting helminth infections in Jonsson U

Label: 4, with a score of: 0.785032401445344
WordScorePoS
education0.244244978014045NN
stunt0NN
infection0NN

Label: 3, with a score of: 0.441887131081908
WordScorePoS
education0.0152605842304358NN
stunt0NN
infection0.122222546933424NN

Label: 2, with a score of: 0.375034137965965
WordScorePoS
education0NN
stunt0.11668334276823NN
infection0NN

jurisdictional collaborations

Label: 0, with a score of: 1

See intersectoral and interjurisdictional coordination INDEX Kenya census omissions in helminth infections in malaria and cognitive impairments in King E

Label: 3, with a score of: 0.957755025590397
WordScorePoS
coordination0NN
infection0.122222546933424NN
malaria0.20370424488904NN

Latin America See also specific countries community health approach in malaria in malnutrition in latrines

Label: 3, with a score of: 0.843150972693744
WordScorePoS
specific0JJ
country0NN
community0NN
health0.191387734041787NN
approach0NN
malaria0.20370424488904NN
malnutrition0NN
latrine0NN

Label: 12, with a score of: 0.340331068778893
WordScorePoS
specific0.0542519672965169JJ
country0NN
community0.0169905820958638NN
health0.0339811641917276NN
approach0.0542519672965169NN
malaria0NN
malnutrition0NN
latrine0NN

See sanitation lead related diseases linear growth and growth faltering diarrhea and infections and rates of retardation factor local government roles Lorntz B

Label: 6, with a score of: 0.550014602410585
WordScorePoS
sanitation0.334686906581616NN
lead0NN
related0.0524959536790166JJ
disease0.103230094596636NN
growth0NN
infection0NN
rate0NN
local0.0181797964452808JJ
government0NN

Label: 8, with a score of: 0.542143047021827
WordScorePoS
sanitation0NN
lead0.0504071033101074NN
related0.0123650647908625JJ
disease0NN
growth0.208565600657229NN
infection0NN
rate0NN
local0.0214106369326177JJ
government0NN

Label: 3, with a score of: 0.480133815400941
WordScorePoS
sanitation0.0249430985430622NN
lead0.025518364538905NN
related0.0125195145191824JJ
disease0.215415047323213NN
growth0NN
infection0.122222546933424NN
rate0.0433561464459019NN
local0JJ
government0NN

malabsorption malaria burden of disease cognition and control strategies drug resistance and environmental risk factors and health systems and mortality pregnancy and treatment and prevention young children and Malawi child survival programs in nutritional status and infectious disease in strength of association study in Malaysia infant mortality in malaria in malnutrition ALRI and areas for future research background on burden of disease cognition and learning impacts diarrhea and early infancy and economic impact of education and environmental factors environmental health valuations and environmental role in childhood health infections and infections affecting malnutrition malnutrition effecting disease mortality and pregnancy and Maluccio J

Label: 3, with a score of: 0.869192591374234
WordScorePoS
malaria0.20370424488904NN
burden0NN
disease0.215415047323213NN
control0.020806307400253NN
strategy0.0149758277542848NN
drug0.0407408489778079NN
environmental0JJ
risk0.0703902516159815NN
health0.191387734041787NN
system0NN
mortality0.276962203701274NN
treatment0.0624189222007589NN
prevention0.0923207345670913NN
child0.10682408961305NN
nutritional0JJ
status0NN
study0NN
infant0NN
malnutrition0NN
future0NN
research0.0175975629039954NN
learn0VB
impact0NN
economic0JJ
education0.0152605842304358NN
childhood0NN
infection0.122222546933424NN
affect0.00625975725959118VB
effect0NN

Label: 4, with a score of: 0.184062836096226
WordScorePoS
malaria0NN
burden0NN
disease0NN
control0NN
strategy0NN
drug0NN
environmental0JJ
risk0NN
health0NN
system0NN
mortality0NN
treatment0NN
prevention0NN
child0.076326555629389NN
nutritional0JJ
status0NN
study0NN
infant0NN
malnutrition0NN
future0NN
research0NN
learn0.244520809605025VB
impact0NN
economic0JJ
education0.244244978014045NN
childhood0.0815069365350084NN
infection0NN
affect0.0125233923809486VB
effect0NN

Label: 8, with a score of: 0.0955743254998536
WordScorePoS
malaria0NN
burden0NN
disease0NN
control0NN
strategy0.0295821503613099NN
drug0NN
environmental0.0295821503613099JJ
risk0NN
health0NN
system0NN
mortality0NN
treatment0NN
prevention0NN
child0.0452169560888236NN
nutritional0JJ
status0NN
study0NN
infant0NN
malnutrition0NN
future0NN
research0NN
learn0VB
impact0NN
economic0.128463821595706JJ
education0.0150723186962745NN
childhood0NN
infection0NN
affect0VB
effect0NN

measles Mediterranean region Mehta S

Label: 1, with a score of: 0.725951540752062
WordScorePoS
measles0NNS
region0.184259548107002NN

Label: 3, with a score of: 0.652352123997568
WordScorePoS
measles0.0407408489778079NNS
region0.124837844401518NN

Mexico Clean Water Program environmental health programs in nutritional status and infectious disease in Universal Vaccination Program MDGs

Label: 6, with a score of: 0.738933870820645
WordScorePoS
clean0.0348974218717993JJ
water0.556409482163189NN
environmental0JJ
health0NN
nutritional0JJ
status0NN
disease0.103230094596636NN
universal0.0153390539205676JJ

Label: 3, with a score of: 0.503996477493615
WordScorePoS
clean0.020806307400253JJ
water0.0382775468083574NN
environmental0JJ
health0.191387734041787NN
nutritional0JJ
status0NN
disease0.215415047323213NN
universal0.0182906962166331JJ

Label: 12, with a score of: 0.292194870301547
WordScorePoS
clean0JJ
water0.186896403054502NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
nutritional0JJ
status0NN
disease0NN
universal0JJ

Label: 7, with a score of: 0.187357167741352
WordScorePoS
clean0.125032076213024JJ
water0NN
environmental0JJ
health0NN
nutritional0JJ
status0NN
disease0NN
universal0.0549574626423028JJ

See Millennium Development Goals miasma theory micronutrient supplementation Middle East malaria in milk See also breastfeeding Millennium Development Goals MDGs Mills A

Label: 3, with a score of: 0.608476016654745
WordScorePoS
millennium0JJ
development0.00837573444202498NN
goal0NN
middle0JJ
malaria0.20370424488904NN

Mills Reincke phenomenon and ratios mobilization Moore S

Label: 1, with a score of: 0.674314847343143
WordScorePoS
ratio0NN
mobilization0.0908430554521382NN

Label: 5, with a score of: 0.51118377964394
WordScorePoS
ratio0.0688661930304451NN
mobilization0NN

Label: 3, with a score of: 0.456855630305638
WordScorePoS
ratio0.0615471563780609NN
mobilization0NN

Morocco costs of environmental degradation in water sector in mortality See also attributable fractions AF diarrheal indoor air pollution malaria and malnutrition and multiplier effect and valuation of mosquito nets

Label: 6, with a score of: 0.624042119093248
WordScorePoS
cost0NN
environmental0JJ
degradation0NN
water0.556409482163189NN
sector0.0214003646985842NN
mortality0NN
air0NN
pollution0.0590310971343993NN
malaria0NN
malnutrition0.041835863322702NN
effect0NN

Label: 3, with a score of: 0.512480372740853
WordScorePoS
cost0NN
environmental0JJ
degradation0NN
water0.0382775468083574NN
sector0NN
mortality0.276962203701274NN
air0.020806307400253NN
pollution0.0175975629039954NN
malaria0.20370424488904NN
malnutrition0NN
effect0NN

Label: 12, with a score of: 0.432083421723159
WordScorePoS
cost0.0277064208763707NN
environmental0.0598270388037045JJ
degradation0.0996453584339239NN
water0.186896403054502NN
sector0.0169905820958638NN
mortality0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
malaria0NN
malnutrition0NN
effect0NN

Label: 15, with a score of: 0.218763918116378
WordScorePoS
cost0NN
environmental0JJ
degradation0.221714625071441NN
water0.016202004209163NN
sector0NN
mortality0NN
air0NN
pollution0NN
malaria0NN
malnutrition0NN
effect0NN

See insecticide treated nets mosquitoes

Label: 0, with a score of: 1

See vector controls Moy R

Label: 1, with a score of: 0.730398396150546
WordScorePoS
control0.0614198493690006NN

Label: 5, with a score of: 0.553699528137647
WordScorePoS
control0.0465610847355851NN

multiplier effects INDEX multisectoral collaborations

Label: 9, with a score of: 0.718120873858835
WordScorePoS
effect0.0454743001434393NN

Label: 2, with a score of: 0.695918393583776
WordScorePoS
effect0.0440683498519077NN

See intersectoral and interjurisdictional coordination Multisectoral Constraints Assessment national government roles National Improved Stove Program NISP China National Nutrition Survey Pakistan National Slum Dwellers Federation India Nepal Alternative Energy Promotion Center child survival programs in hookworm infections in national hand washing campaign in smoke exposure of women in New York City milk regulation Nicaragua integrated child survival programs in intestinal parasites in vector control measures in Nigeria cost of environmental health risks in indoor air pollution in nutritional status and infectious disease in strength of association study in Total Sanitation Campaign in nutrition programs occupational risk factors oral rehydration therapy outdoor air pollution Pakistan ALRI in basic indicators for childhood weight in cost of environmental health risks in diarrhea in environmental health valuations in fuels in GDP in malaria in malnutrition in mortality valuation in nutritional status and infectious disease in sanitation campaigns in school enrollment in United Nations Children Fund Pakistan Demographic and Health Survey Pakistan Social and Living Standards Measurement Survey Pan American Health Organization parasites

Label: 3, with a score of: 0.61474648127085
WordScorePoS
coordination0NN
constraint0NN
national0.00558382296134999JJ
government0NN
improve0VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0NN
promotion0NN
child0.10682408961305NN
infection0.122222546933424NN
exposure0NN
woman0.0381514605760894NN
city0NN
regulation0NN
integrate0VB
control0.020806307400253NN
measure0NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
air0.020806307400253NN
pollution0.0175975629039954NN
nutritional0JJ
status0NN
disease0.215415047323213NN
study0NN
total0NN
sanitation0.0249430985430622NN
therapy0.0407408489778079NN
basic0JJ
childhood0NN
fuel0NN
gdp0NN
malaria0.20370424488904NN
malnutrition0NN
mortality0.276962203701274NN
school0NN
unite0VB
nation0NN
fund0NN
social0JJ
live0.0300513417930436VB
standard0NN
measurement0NN
organization0.0175975629039954NN

Label: 11, with a score of: 0.39369622505569
WordScorePoS
coordination0NN
constraint0NN
national0.00501208088147356JJ
government0NN
improve0.0273960270556257VB
nutrition0NN
survey0NN
slum0.146277152173395NN
alternative0NN
energy0.0492535935240667NN
promotion0NN
child0.0273960270556257NN
infection0NN
exposure0NN
woman0.0273960270556257NN
city0.607697021770652NN
regulation0NN
integrate0.0537696560159885VB
control0NN
measure0NN
cost0NN
environmental0.0537696560159885JJ
health0.0229054731708393NN
risk0.0631828116343571NN
air0.0373517915079663NN
pollution0.0315914058171786NN
nutritional0JJ
status0NN
disease0NN
study0NN
total0NN
sanitation0NN
therapy0NN
basic0.0583751976558017JJ
childhood0NN
fuel0NN
gdp0NN
malaria0NN
malnutrition0NN
mortality0NN
school0NN
unite0VB
nation0NN
fund0.055245183797332NN
social0.0458109463416786JJ
live0.0269743071558856VB
standard0NN
measurement0NN
organization0NN

Label: 6, with a score of: 0.280759838908179
WordScorePoS
coordination0NN
constraint0NN
national0JJ
government0NN
improve0.0511916925627245VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0.0153390539205676NN
promotion0NN
child0.0255958462813622NN
infection0NN
exposure0NN
woman0.0127979231406811NN
city0NN
regulation0NN
integrate0.0251182378961834VB
control0NN
measure0NN
cost0NN
environmental0JJ
health0NN
risk0NN
air0NN
pollution0.0590310971343993NN
nutritional0JJ
status0NN
disease0.103230094596636NN
study0NN
total0.0295155485671997NN
sanitation0.334686906581616NN
therapy0NN
basic0.0181797964452808JJ
childhood0NN
fuel0NN
gdp0NN
malaria0NN
malnutrition0.041835863322702NN
mortality0NN
school0NN
unite0VB
nation0NN
fund0NN
social0JJ
live0.0252018374089947VB
standard0NN
measurement0NN
organization0NN

Label: 2, with a score of: 0.221004262553426
WordScorePoS
coordination0NN
constraint0NN
national0.00399807039435538JJ
government0NN
improve0.0218534471578307VB
nutrition0.175025014152344NN
survey0NN
slum0NN
alternative0NN
energy0.0130963126055467NN
promotion0NN
child0.0546336178945768NN
infection0NN
exposure0NN
woman0.0546336178945768NN
city0.0440683498519077NN
regulation0NN
integrate0VB
control0NN
measure0.0504000902222448NN
cost0NN
environmental0JJ
health0NN
risk0.0252000451111224NN
air0NN
pollution0NN
nutritional0.0583416713841148JJ
status0NN
disease0NN
study0NN
total0.0252000451111224NN
sanitation0NN
therapy0NN
basic0JJ
childhood0NN
fuel0NN
gdp0NN
malaria0NN
malnutrition0.0357189919948307NN
mortality0NN
school0.0297950283197006NN
unite0VB
nation0NN
fund0NN
social0JJ
live0.0143446978608332VB
standard0NN
measurement0NN
organization0NN

Label: 5, with a score of: 0.204255890235153
WordScorePoS
coordination0NN
constraint0NN
national0.0124956749436837JJ
government0NN
improve0VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0NN
promotion0.0931221694711702NN
child0.0170753354211044NN
infection0NN
exposure0NN
woman0.221979360474357NN
city0NN
regulation0NN
integrate0VB
control0.0465610847355851NN
measure0NN
cost0NN
environmental0JJ
health0.0571058915334038NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
disease0NN
study0NN
total0NN
sanitation0NN
therapy0NN
basic0JJ
childhood0NN
fuel0.0558185411034276NN
gdp0NN
malaria0NN
malnutrition0NN
mortality0NN
school0.0931221694711702NN
unite0VB
nation0NN
fund0NN
social0.0285529457667019JJ
live0VB
standard0NN
measurement0NN
organization0NN

Label: 12, with a score of: 0.197218627928249
WordScorePoS
coordination0NN
constraint0NN
national0.00743561777158133JJ
government0NN
improve0VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0.133960988253756NN
promotion0NN
child0NN
infection0NN
exposure0NN
woman0NN
city0NN
regulation0NN
integrate0.0199423462679015VB
control0NN
measure0NN
cost0.0277064208763707NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
risk0NN
air0.0554128417527413NN
pollution0.0234335422829798NN
nutritional0JJ
status0NN
disease0NN
study0NN
total0.0468670845659596NN
sanitation0NN
therapy0NN
basic0.0144336476662975JJ
childhood0NN
fuel0.0332151194779746NN
gdp0NN
malaria0NN
malnutrition0NN
mortality0NN
school0NN
unite0VB
nation0NN
fund0NN
social0.0169905820958638JJ
live0VB
standard0.0409791940864438NN
measurement0NN
organization0NN

Label: 4, with a score of: 0.155683961966756
WordScorePoS
coordination0NN
constraint0NN
national0JJ
government0NN
improve0.0305306222517556VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0NN
promotion0.0416255041156371NN
child0.076326555629389NN
infection0NN
exposure0NN
woman0.0610612445035112NN
city0NN
regulation0NN
integrate0VB
control0NN
measure0NN
cost0NN
environmental0JJ
health0NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
disease0NN
study0NN
total0NN
sanitation0NN
therapy0NN
basic0.0433695758119029JJ
childhood0.0815069365350084NN
fuel0NN
gdp0NN
malaria0NN
malnutrition0NN
mortality0NN
school0.208127520578185NN
unite0VB
nation0NN
fund0NN
social0JJ
live0.0200404333715257VB
standard0NN
measurement0NN
organization0NN

Label: 7, with a score of: 0.140474029426009
WordScorePoS
coordination0NN
constraint0NN
national0JJ
government0NN
improve0.0229264916384433VB
nutrition0NN
survey0NN
slum0NN
alternative0NN
energy0.494617163780726NN
promotion0NN
child0NN
infection0NN
exposure0NN
woman0NN
city0NN
regulation0NN
integrate0VB
control0NN
measure0NN
cost0NN
environmental0JJ
health0NN
risk0NN
air0NN
pollution0NN
nutritional0JJ
status0NN
disease0NN
study0NN
total0.0528748274225028NN
sanitation0NN
therapy0NN
basic0JJ
childhood0NN
fuel0.0749457204978913NN
gdp0NN
malaria0NN
malnutrition0NN
mortality0NN
school0NN
unite0VB
nation0NN
fund0NN
social0JJ
live0VB
standard0NN
measurement0NN
organization0NN

See helminth infections Pasteur Louis Patrinos H

Label: 3, with a score of: 1
WordScorePoS
infection0.122222546933424NN

Pediatric Nutrition Handbook American Academy of Pediatrics Peru cost benefit analysis in cost of environmental health risks in diarrhea in hygiene in infrastructure improvements in Integrated Management of Childhood Illness in nutritional status and infectious disease in school performance in Philippines infant mortality causes in Interagency Committee on Environmental Health malnutrition and educational outcomes in nutritional status and infectious disease in pneumococcal infections

Label: 3, with a score of: 0.732202712940822
WordScorePoS
nutrition0NN
cost0NN
benefit0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
hygiene0NN
infrastructure0NN
improvement0NN
integrate0VB
management0.0127591822694525NN
childhood0NN
illness0.0407408489778079NN
nutritional0JJ
status0NN
disease0.215415047323213NN
school0NN
performance0NN
infant0NN
mortality0.276962203701274NN
malnutrition0NN
educational0JJ
outcome0NN
infection0.122222546933424NN

Label: 6, with a score of: 0.295466918442862
WordScorePoS
nutrition0NN
cost0NN
benefit0NN
environmental0JJ
health0NN
risk0NN
hygiene0.136665345449673NN
infrastructure0.0181797964452808NN
improvement0NN
integrate0.0251182378961834VB
management0.0428007293971684NN
childhood0NN
illness0NN
nutritional0JJ
status0NN
disease0.103230094596636NN
school0NN
performance0NN
infant0NN
mortality0NN
malnutrition0.041835863322702NN
educational0.0683326727248364JJ
outcome0NN
infection0NN

Label: 2, with a score of: 0.263746809377646
WordScorePoS
nutrition0.175025014152344NN
cost0NN
benefit0.0252000451111224NN
environmental0JJ
health0NN
risk0.0252000451111224NN
hygiene0NN
infrastructure0.0155217067874935NN
improvement0NN
integrate0VB
management0NN
childhood0NN
illness0NN
nutritional0.0583416713841148JJ
status0NN
disease0NN
school0.0297950283197006NN
performance0NN
infant0.0583416713841148NN
mortality0NN
malnutrition0.0357189919948307NN
educational0JJ
outcome0NN
infection0NN

Label: 9, with a score of: 0.226836514433316
WordScorePoS
nutrition0NN
cost0NN
benefit0.0260040237236563NN
environmental0.0221298700466866JJ
health0.0377086395700813NN
risk0NN
hygiene0NN
infrastructure0.192202909044225NN
improvement0.0454743001434393NN
integrate0VB
management0NN
childhood0NN
illness0NN
nutritional0JJ
status0NN
disease0NN
school0NN
performance0NN
infant0NN
mortality0NN
malnutrition0NN
educational0JJ
outcome0.030745604615229NN
infection0NN

Label: 4, with a score of: 0.181456544656133
WordScorePoS
nutrition0NN
cost0NN
benefit0NN
environmental0JJ
health0NN
risk0NN
hygiene0NN
infrastructure0NN
improvement0NN
integrate0VB
management0NN
childhood0.0815069365350084NN
illness0NN
nutritional0JJ
status0NN
disease0NN
school0.208127520578185NN
performance0NN
infant0NN
mortality0NN
malnutrition0NN
educational0JJ
outcome0.0416255041156371NN
infection0NN

See pneumonia pneumonia political will and consensus Powanda M

Label: 10, with a score of: 0.774452061623384
WordScorePoS
political0.0792212041430275JJ
consensus0.064698038783335NN

Label: 5, with a score of: 0.600736681980428
WordScorePoS
political0.111637082206855JJ
consensus0NN

Prado M

Label: 0, with a score of: 1

pregnancy See also fetuses environmental risk factors during fetal protection health systems and malaria and Preventing Disease through Healthy Environments Prüss Üstün Corvalán prevention

Label: 3, with a score of: 0.857757564258424
WordScorePoS
environmental0JJ
risk0.0703902516159815NN
protection0.020806307400253NN
health0.191387734041787NN
system0NN
malaria0.20370424488904NN
prevent0VB
disease0.215415047323213NN
healthy0.0615471563780609JJ
environment0NN
prevention0.0923207345670913NN

See primary prevention primary prevention private sector Prüss Üstün A

Label: 5, with a score of: 0.631548974448646
WordScorePoS
primary0.0970239057629001JJ
prevention0NN
private0.0558185411034276JJ
sector0.0571058915334038NN

Label: 4, with a score of: 0.446131721142988
WordScorePoS
primary0.108423939529757JJ
prevention0NN
private0JJ
sector0NN

Label: 3, with a score of: 0.424471260389683
WordScorePoS
primary0.0108390366114755JJ
prevention0.0923207345670913NN
private0JJ
sector0NN

INDEX Psacharopoulos G

Label: 0, with a score of: 1

public health personnel public sectors Pubmed Ramalingaswami V

Label: 3, with a score of: 0.530451498096214
WordScorePoS
public0.021678073222951NN
health0.191387734041787NN
sector0NN

Label: 5, with a score of: 0.586952577363857
WordScorePoS
public0.0727679293221751NN
health0.0571058915334038NN
sector0.0571058915334038NN

Label: 11, with a score of: 0.315580813014312
WordScorePoS
public0.0583751976558017NN
health0.0229054731708393NN
sector0NN

regulations Clean Water Program in Mexico colonial history of health sector interjurisdictional coordination local government national government framework for need to develop New York City milk regulation sanitation in Ethiopia trend of enacting Report of the Royal Sanitary Commission UK Repositioning Nutrition as Central to Development World Bank residual spraying

Label: 6, with a score of: 0.630048259679964
WordScorePoS
regulation0NN
clean0.0348974218717993JJ
water0.556409482163189NN
history0NN
health0NN
sector0.0214003646985842NN
coordination0NN
local0.0181797964452808JJ
government0NN
national0JJ
framework0NN
develop0VB
city0NN
sanitation0.334686906581616NN
report0NN
commission0NN
nutrition0NN
central0JJ
development0NN
world0.00438651305628668NN
bank0NN

Label: 11, with a score of: 0.478483668124686
WordScorePoS
regulation0NN
clean0JJ
water0.0458109463416786NN
history0NN
health0.0229054731708393NN
sector0NN
coordination0NN
local0.0194583992186006JJ
government0NN
national0.00501208088147356JJ
framework0.0194583992186006NN
develop0VB
city0.607697021770652NN
sanitation0NN
report0NN
commission0NN
nutrition0NN
central0JJ
development0.0100241617629471NN
world0.00626002771693937NN
bank0NN

Label: 2, with a score of: 0.271234300045452
WordScorePoS
regulation0NN
clean0JJ
water0NN
history0NN
health0NN
sector0.0182713919265625NN
coordination0NN
local0.0155217067874935JJ
government0NN
national0.00399807039435538JJ
framework0NN
develop0VB
city0.0440683498519077NN
sanitation0NN
report0NN
commission0NN
nutrition0.175025014152344NN
central0.0440683498519077JJ
development0.0159922815774215NN
world0.0124838525528648NN
bank0.0881366997038154NN

Label: 12, with a score of: 0.231590658185264
WordScorePoS
regulation0NN
clean0JJ
water0.186896403054502NN
history0NN
health0.0339811641917276NN
sector0.0169905820958638NN
coordination0NN
local0.0144336476662975JJ
government0NN
national0.00743561777158133JJ
framework0.028867295332595NN
develop0VB
city0NN
sanitation0NN
report0.0409791940864438NN
commission0NN
nutrition0NN
central0JJ
development0.022306853314744NN
world0.00464349782489754NN
bank0NN

Label: 3, with a score of: 0.215562337126705
WordScorePoS
regulation0NN
clean0.020806307400253JJ
water0.0382775468083574NN
history0NN
health0.191387734041787NN
sector0NN
coordination0NN
local0JJ
government0NN
national0.00558382296134999JJ
framework0.0108390366114755NN
develop0VB
city0NN
sanitation0.0249430985430622NN
report0.0307735781890304NN
commission0NN
nutrition0NN
central0JJ
development0.00837573444202498NN
world0.00087176582269799NN
bank0NN

Label: 7, with a score of: 0.142978594874944
WordScorePoS
regulation0NN
clean0.125032076213024JJ
water0NN
history0NN
health0NN
sector0NN
coordination0NN
local0JJ
government0NN
national0JJ
framework0NN
develop0VB
city0NN
sanitation0NN
report0NN
commission0NN
nutrition0NN
central0.0924643738905717JJ
development0NN
world0.00261936653839306NN
bank0NN

See indoor residual spraying residual transmission

Label: 0, with a score of: 1

See transmission routes retardation factor

Label: 0, with a score of: 1

See linear growth and growth faltering weight retardation factors Rohde J

Label: 8, with a score of: 0.851431893492884
WordScorePoS
growth0.208565600657229NN

Label: 10, with a score of: 0.456331861301254
WordScorePoS
growth0.11178243319132NN

rotavirus St

Label: 0, with a score of: 1

Lucia sanitation burden of disease child delivery and diarrhea and environmental risk factors and hookworm infections and infrastructure improvements to maternal and childhood underweight as Millennium Development Goal related diseases in rural areas as second generation health intervention vaccines and school performance

Label: 3, with a score of: 0.764471721318732
WordScorePoS
sanitation0.0249430985430622NN
burden0NN
disease0.215415047323213NN
child0.10682408961305NN
environmental0JJ
risk0.0703902516159815NN
infection0.122222546933424NN
infrastructure0NN
improvement0NN
maternal0.184641469134183JJ
childhood0NN
millennium0JJ
development0.00837573444202498NN
goal0NN
related0.0125195145191824JJ
rural0JJ
generation0NN
health0.191387734041787NN
intervention0.0407408489778079NN
vaccine0.162963395911232NN
school0NN
performance0NN

Label: 6, with a score of: 0.35940007955436
WordScorePoS
sanitation0.334686906581616NN
burden0NN
disease0.103230094596636NN
child0.0255958462813622NN
environmental0JJ
risk0NN
infection0NN
infrastructure0.0181797964452808NN
improvement0NN
maternal0JJ
childhood0NN
millennium0JJ
development0NN
goal0NN
related0.0524959536790166JJ
rural0JJ
generation0NN
health0NN
intervention0NN
vaccine0NN
school0NN
performance0NN

Label: 9, with a score of: 0.284419847461733
WordScorePoS
sanitation0.0737171311497939NN
burden0NN
disease0NN
child0NN
environmental0.0221298700466866JJ
risk0NN
infection0NN
infrastructure0.192202909044225NN
improvement0.0454743001434393NN
maternal0JJ
childhood0NN
millennium0JJ
development0.0330049940546426NN
goal0NN
related0.00925008066007716JJ
rural0JJ
generation0.0909486002868787NN
health0.0377086395700813NN
intervention0NN
vaccine0NN
school0NN
performance0NN

Label: 4, with a score of: 0.22208896434756
WordScorePoS
sanitation0NN
burden0NN
disease0NN
child0.076326555629389NN
environmental0JJ
risk0NN
infection0NN
infrastructure0NN
improvement0NN
maternal0JJ
childhood0.0815069365350084NN
millennium0JJ
development0.0279277626235394NN
goal0NN
related0JJ
rural0JJ
generation0NN
health0NN
intervention0NN
vaccine0NN
school0.208127520578185NN
performance0NN

Label: 2, with a score of: 0.193480726610609
WordScorePoS
sanitation0NN
burden0.0440683498519077NN
disease0NN
child0.0546336178945768NN
environmental0JJ
risk0.0252000451111224NN
infection0NN
infrastructure0.0155217067874935NN
improvement0NN
maternal0JJ
childhood0NN
millennium0JJ
development0.0159922815774215NN
goal0NN
related0.00896409157262106JJ
rural0.148975141598503JJ
generation0NN
health0NN
intervention0NN
vaccine0NN
school0.0297950283197006NN
performance0NN

See cognition education Scrimshaw N

Label: 4, with a score of: 0.961591108592945
WordScorePoS
education0.244244978014045NN

Senegal Silent Spring Carson Smith K

Label: 0, with a score of: 1

Snow John soap

Label: 13, with a score of: 1
WordScorePoS
snow0.0548233071065585NN

See hygiene handwashing South Africa environmental health officials in spraying

Label: 3, with a score of: 0.610718075437393
WordScorePoS
hygiene0NN
south0RB
africa0IN
environmental0JJ
health0.191387734041787NN
official0NN

Label: 6, with a score of: 0.436098986018546
WordScorePoS
hygiene0.136665345449673NN
south0RB
africa0IN
environmental0JJ
health0NN
official0NN

Label: 10, with a score of: 0.361144401891839
WordScorePoS
hygiene0NN
south0RB
africa0IN
environmental0.0237821918091848JJ
health0.0405241466500776NN
official0.0488696285210061NN

See indoor residual spraying stoves

Label: 0, with a score of: 1

See cookstoves strategies

Label: 1, with a score of: 0.686656441771374
WordScorePoS
strategy0.0442083771593746NN

Label: 8, with a score of: 0.459477940884682
WordScorePoS
strategy0.0295821503613099NN

Label: 13, with a score of: 0.313011949514095
WordScorePoS
strategy0.0201523636533764NN

See child survival strategies strength of association studies stunting

Label: 2, with a score of: 0.624563685090426
WordScorePoS
child0.0546336178945768NN
strategy0NN
study0NN
stunt0.11668334276823NN

Label: 3, with a score of: 0.44404129597174
WordScorePoS
child0.10682408961305NN
strategy0.0149758277542848NN
study0NN
stunt0NN

Label: 1, with a score of: 0.325402105277404
WordScorePoS
child0.0450489732120807NN
strategy0.0442083771593746NN
study0NN
stunt0NN

See birth weight linear growth and growth faltering underweight Sub Saharan Africa See also specific countries birth weight in burden of disease in education in environmental health interventions in hookworms in immunization in malaria in malnutrition in vector control programs in weight of children in compared to Asian children Sudan nutritional status and infectious disease in water and food budgets in supplements

Label: 3, with a score of: 0.649573267964655
WordScorePoS
birth0.0748292956291867NN
growth0NN
saharan0.0299516555085695JJ
africa0IN
specific0JJ
country0NN
burden0NN
disease0.215415047323213NN
education0.0152605842304358NN
environmental0JJ
health0.191387734041787NN
intervention0.0407408489778079NN
malaria0.20370424488904NN
malnutrition0NN
control0.020806307400253NN
child0.10682408961305NN
compare0.0307735781890304VB
nutritional0JJ
status0NN
water0.0382775468083574NN
food0NN

Label: 6, with a score of: 0.41747445407975
WordScorePoS
birth0NN
growth0NN
saharan0JJ
africa0IN
specific0JJ
country0NN
burden0NN
disease0.103230094596636NN
education0NN
environmental0JJ
health0NN
intervention0NN
malaria0NN
malnutrition0.041835863322702NN
control0NN
child0.0255958462813622NN
compare0VB
nutritional0JJ
status0NN
water0.556409482163189NN
food0.0214003646985842NN

Label: 2, with a score of: 0.291031020697582
WordScorePoS
birth0NN
growth0.0252000451111224NN
saharan0.0214456704626236JJ
africa0IN
specific0JJ
country0NN
burden0.0440683498519077NN
disease0NN
education0NN
environmental0JJ
health0NN
intervention0NN
malaria0NN
malnutrition0.0357189919948307NN
control0NN
child0.0546336178945768NN
compare0VB
nutritional0.0583416713841148JJ
status0NN
water0NN
food0.292342270824999NN

Label: 8, with a score of: 0.262781490425797
WordScorePoS
birth0NN
growth0.208565600657229NN
saharan0JJ
africa0IN
specific0JJ
country0NN
burden0NN
disease0NN
education0.0150723186962745NN
environmental0.0295821503613099JJ
health0NN
intervention0NN
malaria0NN
malnutrition0NN
control0NN
child0.0452169560888236NN
compare0VB
nutritional0JJ
status0NN
water0NN
food0NN

Label: 12, with a score of: 0.253166257373807
WordScorePoS
birth0NN
growth0NN
saharan0JJ
africa0IN
specific0.0542519672965169JJ
country0NN
burden0NN
disease0NN
education0.0101607690729067NN
environmental0.0598270388037045JJ
health0.0339811641917276NN
intervention0NN
malaria0NN
malnutrition0NN
control0NN
child0NN
compare0VB
nutritional0JJ
status0NN
water0.186896403054502NN
food0.186896403054502NN

Label: 4, with a score of: 0.203126896603641
WordScorePoS
birth0NN
growth0NN
saharan0.0299609328954485JJ
africa0IN
specific0JJ
country0NN
burden0NN
disease0NN
education0.244244978014045NN
environmental0JJ
health0NN
intervention0NN
malaria0NN
malnutrition0NN
control0NN
child0.076326555629389NN
compare0VB
nutritional0JJ
status0NN
water0NN
food0NN

See micronutrient supplementation Taylor C

Label: 0, with a score of: 1

Teklemariam Shiferaw tetanus Thailand community empowerment in nutrition programs in Total Sanitation Campaign Bangladesh transmission routes trypanosomiasis Tunisia cost of environmental health risks in plan to develop unit of environmental economics and policy typhoid fever underweight See also birth weight defined INDEX diarrhea and factors for See also weight retardation factors infections and rates of United Nations Children Fund UNICEF United States correlation between diarrheal disease and malnutrition in devolution of authority in rural sanitation initiatives in Universal Vaccination Program Mexico vaccinations See also immunizations Valdmanis V

Label: 6, with a score of: 0.541895688611917
WordScorePoS
community0.0214003646985842NN
empowerment0NN
nutrition0NN
total0.0295155485671997NN
sanitation0.334686906581616NN
cost0NN
environmental0JJ
health0NN
risk0NN
plan0NN
develop0VB
economics0.0683326727248364NNS
policy0NN
birth0NN
infection0NN
rate0NN
unite0VB
nation0NN
child0.0255958462813622NN
fund0NN
disease0.103230094596636NN
malnutrition0.041835863322702NN
rural0JJ
initiative0NN
universal0.0153390539205676JJ

Label: 3, with a score of: 0.508344561678782
WordScorePoS
community0NN
empowerment0NN
nutrition0NN
total0NN
sanitation0.0249430985430622NN
cost0NN
environmental0JJ
health0.191387734041787NN
risk0.0703902516159815NN
plan0.021678073222951NN
develop0VB
economics0NNS
policy0NN
birth0.0748292956291867NN
infection0.122222546933424NN
rate0.0433561464459019NN
unite0VB
nation0NN
child0.10682408961305NN
fund0NN
disease0.215415047323213NN
malnutrition0NN
rural0JJ
initiative0NN
universal0.0182906962166331JJ

Label: 2, with a score of: 0.277194188978487
WordScorePoS
community0.0182713919265625NN
empowerment0NN
nutrition0.175025014152344NN
total0.0252000451111224NN
sanitation0NN
cost0NN
environmental0JJ
health0NN
risk0.0252000451111224NN
plan0NN
develop0VB
economics0NNS
policy0NN
birth0NN
infection0NN
rate0.0155217067874935NN
unite0VB
nation0NN
child0.0546336178945768NN
fund0NN
disease0NN
malnutrition0.0357189919948307NN
rural0.148975141598503JJ
initiative0NN
universal0JJ

Label: 5, with a score of: 0.223687368931109
WordScorePoS
community0NN
empowerment0.273513903975916NN
nutrition0NN
total0NN
sanitation0NN
cost0NN
environmental0JJ
health0.0571058915334038NN
risk0NN
plan0NN
develop0VB
economics0NNS
policy0.0341506708422088NN
birth0NN
infection0NN
rate0NN
unite0VB
nation0NN
child0.0170753354211044NN
fund0NN
disease0NN
malnutrition0NN
rural0JJ
initiative0NN
universal0.02046578088155JJ

valuations

Label: 0, with a score of: 1

See environmental health valuations van Geertruyden J

Label: 3, with a score of: 0.748428669010577
WordScorePoS
environmental0JJ
health0.191387734041787NN

Label: 12, with a score of: 0.366840377005645
WordScorePoS
environmental0.0598270388037045JJ
health0.0339811641917276NN

vector control See also dengue virus Vietnam vector control programs in vitamins and vitamin deficiencies

Label: 0, with a score of: 1

See micronutrient supplementation wage losses

Label: 15, with a score of: 0.588794084253939
WordScorePoS
wage0NN
loss0.0670377886812128NN

Label: 10, with a score of: 0.568244019497847
WordScorePoS
wage0.064698038783335NN
loss0NN

Label: 12, with a score of: 0.411634433079079
WordScorePoS
wage0NN
loss0.0468670845659596NN

See income losses Walker S

Label: 10, with a score of: 0.696210645058963
WordScorePoS
income0.166475342664294NN
loss0NN

Label: 9, with a score of: 0.462742735761892
WordScorePoS
income0.110649350233433NN
loss0NN

wastewater treatment wasting

Label: 6, with a score of: 0.805680449544676
WordScorePoS
wastewater0.204998018174509NN
treatment0.0348974218717993NN
waste0NN

Label: 12, with a score of: 0.465255230000188
WordScorePoS
wastewater0NN
treatment0NN
waste0.138532104381853NN

See birth weight linear growth and growth faltering underweight water burden of disease child delivery and Clean Water Program Mexico cost of diarrhea and environmental risk factors of fecal pollution and hookworm infections and improvement of supply infrastructure improvements to malaria and maternal and childhood underweight during pregnancy privatization of supply related diseases vaccines and weight

Label: 6, with a score of: 0.638068386335103
WordScorePoS
birth0NN
growth0NN
water0.556409482163189NN
burden0NN
disease0.103230094596636NN
child0.0255958462813622NN
clean0.0348974218717993JJ
cost0NN
environmental0JJ
risk0NN
pollution0.0590310971343993NN
infection0NN
improvement0NN
supply0.0590310971343993NN
infrastructure0.0181797964452808NN
malaria0NN
maternal0JJ
childhood0NN
related0.0524959536790166JJ
vaccine0NN

Label: 3, with a score of: 0.581748241635626
WordScorePoS
birth0.0748292956291867NN
growth0NN
water0.0382775468083574NN
burden0NN
disease0.215415047323213NN
child0.10682408961305NN
clean0.020806307400253JJ
cost0NN
environmental0JJ
risk0.0703902516159815NN
pollution0.0175975629039954NN
infection0.122222546933424NN
improvement0NN
supply0NN
infrastructure0NN
malaria0.20370424488904NN
maternal0.184641469134183JJ
childhood0NN
related0.0125195145191824JJ
vaccine0.162963395911232NN

Label: 12, with a score of: 0.2597544815407
WordScorePoS
birth0NN
growth0NN
water0.186896403054502NN
burden0NN
disease0NN
child0NN
clean0JJ
cost0.0277064208763707NN
environmental0.0598270388037045JJ
risk0NN
pollution0.0234335422829798NN
infection0NN
improvement0NN
supply0.0703006268489394NN
infrastructure0.028867295332595NN
malaria0NN
maternal0JJ
childhood0NN
related0.00833571598658786JJ
vaccine0NN

Label: 8, with a score of: 0.197706136450741
WordScorePoS
birth0NN
growth0.208565600657229NN
water0NN
burden0NN
disease0NN
child0.0452169560888236NN
clean0JJ
cost0NN
environmental0.0295821503613099JJ
risk0NN
pollution0NN
infection0NN
improvement0NN
supply0NN
infrastructure0NN
malaria0NN
maternal0JJ
childhood0NN
related0.0123650647908625JJ
vaccine0NN

Label: 7, with a score of: 0.188512897451635
WordScorePoS
birth0NN
growth0NN
water0NN
burden0NN
disease0NN
child0NN
clean0.125032076213024JJ
cost0NN
environmental0JJ
risk0NN
pollution0NN
infection0NN
improvement0.0924643738905717NN
supply0.0528748274225028NN
infrastructure0.0651354046449052NN
malaria0NN
maternal0JJ
childhood0NN
related0JJ
vaccine0NN

Label: 9, with a score of: 0.185320287571989
WordScorePoS
birth0NN
growth0.0260040237236563NN
water0.0377086395700813NN
burden0NN
disease0NN
child0NN
clean0.030745604615229JJ
cost0NN
environmental0.0221298700466866JJ
risk0NN
pollution0NN
infection0NN
improvement0.0454743001434393NN
supply0NN
infrastructure0.192202909044225NN
malaria0NN
maternal0JJ
childhood0NN
related0.00925008066007716JJ
vaccine0NN

See birth weight underweight weight retardation factors WHO

Label: 3, with a score of: 0.697805709734311
WordScorePoS
birth0.0748292956291867NN

Label: 16, with a score of: 0.613697827816785
WordScorePoS
birth0.0658099748168827NN

See World Health Organization whooping cough willingness to pay WTP approach window of opportunity World Bank environmental degradation valuation Health Nutrition and Population strategy Health Sector Strategy nutrition studies Repositioning Nutrition as Central to Development World Health Organization WHO antihelminthics recommended by burden of disease studies Comparative Risk Assessment drug resistance studies environmental health defined by environmental risk factor studies hygiene assessment infection studies Integrated Management of Childhood Illness IMCI malnutrition studies underweight assessment World Health Report WHO worms

Label: 3, with a score of: 0.687549240569581
WordScorePoS
world0.00087176582269799NN
health0.191387734041787NN
organization0.0175975629039954NN
pay0NN
approach0NN
opportunity0NN
bank0NN
environmental0JJ
degradation0NN
nutrition0NN
population0NN
strategy0.0149758277542848NN
sector0NN
study0NN
central0JJ
development0.00837573444202498NN
recommend0.0407408489778079VB
burden0NN
disease0.215415047323213NN
risk0.0703902516159815NN
drug0.0407408489778079NN
hygiene0NN
infection0.122222546933424NN
integrate0VB
management0.0127591822694525NN
childhood0NN
illness0.0407408489778079NN
malnutrition0NN
report0.0307735781890304NN

Label: 2, with a score of: 0.341622413484075
WordScorePoS
world0.0124838525528648NN
health0NN
organization0NN
pay0NN
approach0NN
opportunity0.0261926252110933NN
bank0.0881366997038154NN
environmental0JJ
degradation0NN
nutrition0.175025014152344NN
population0.0310434135749871NN
strategy0NN
sector0.0182713919265625NN
study0NN
central0.0440683498519077JJ
development0.0159922815774215NN
recommend0VB
burden0.0440683498519077NN
disease0NN
risk0.0252000451111224NN
drug0NN
hygiene0NN
infection0NN
integrate0VB
management0NN
childhood0NN
illness0NN
malnutrition0.0357189919948307NN
report0NN

Label: 15, with a score of: 0.265863522871979
WordScorePoS
world0.00110699520004297NN
health0NN
organization0NN
pay0NN
approach0NN
opportunity0.0116130458375813NN
bank0NN
environmental0JJ
degradation0.221714625071441NN
nutrition0NN
population0.0137637438743113NN
strategy0.0190167691930804NN
sector0NN
study0.0517339898971162NN
central0JJ
development0.0106357666046841NN
recommend0VB
burden0NN
disease0NN
risk0.0223459295604043NN
drug0NN
hygiene0NN
infection0NN
integrate0.0190167691930804VB
management0.0486060126274891NN
childhood0NN
illness0NN
malnutrition0NN
report0NN

Label: 6, with a score of: 0.172782291351782
WordScorePoS
world0.00438651305628668NN
health0NN
organization0NN
pay0.0295155485671997NN
approach0NN
opportunity0.0153390539205676NN
bank0NN
environmental0JJ
degradation0NN
nutrition0NN
population0.0363595928905615NN
strategy0NN
sector0.0214003646985842NN
study0NN
central0JJ
development0NN
recommend0VB
burden0NN
disease0.103230094596636NN
risk0NN
drug0NN
hygiene0.136665345449673NN
infection0NN
integrate0.0251182378961834VB
management0.0428007293971684NN
childhood0NN
illness0NN
malnutrition0.041835863322702NN
report0NN

See deworming helminth infections WSH

Label: 3, with a score of: 1
WordScorePoS
infection0.122222546933424NN

See hygiene sanitation water WTP willingness to pay approach young children

Label: 6, with a score of: 0.941090604044039
WordScorePoS
hygiene0.136665345449673NN
sanitation0.334686906581616NN
water0.556409482163189NN
pay0.0295155485671997NN
approach0NN
child0.0255958462813622NN

Label: 12, with a score of: 0.209574380812672
WordScorePoS
hygiene0NN
sanitation0NN
water0.186896403054502NN
pay0NN
approach0.0542519672965169NN
child0NN

See infants and young children Zimbabwe indoor air pollution in malnutrition and educational outcomes in nutritional status and infectious disease in ECO AUDIT Environmental Benefits Statement The World Bank is committed to preserving endangered forests and natural resources

Label: 15, with a score of: 0.477689296599135
WordScorePoS
infant0NN
child0NN
air0NN
pollution0NN
malnutrition0NN
educational0JJ
outcome0NN
nutritional0JJ
status0NN
disease0NN
audit0NN
environmental0JJ
benefit0.0446918591208085NN
world0.00110699520004297NN
bank0NN
forest0.380082214408185NN
natural0.016202004209163JJ
resource0.0317953333768269NN

Label: 3, with a score of: 0.364422044459983
WordScorePoS
infant0NN
child0.10682408961305NN
air0.020806307400253NN
pollution0.0175975629039954NN
malnutrition0NN
educational0JJ
outcome0NN
nutritional0JJ
status0NN
disease0.215415047323213NN
audit0NN
environmental0JJ
benefit0NN
world0.00087176582269799NN
bank0NN
forest0NN
natural0JJ
resource0NN

Label: 2, with a score of: 0.407684315699287
WordScorePoS
infant0.0583416713841148NN
child0.0546336178945768NN
air0NN
pollution0NN
malnutrition0.0357189919948307NN
educational0JJ
outcome0NN
nutritional0.0583416713841148JJ
status0NN
disease0NN
audit0NN
environmental0JJ
benefit0.0252000451111224NN
world0.0124838525528648NN
bank0.0881366997038154NN
forest0.0357189919948307NN
natural0JJ
resource0.0358563662904843NN

Label: 6, with a score of: 0.379172452476536
WordScorePoS
infant0NN
child0.0255958462813622NN
air0NN
pollution0.0590310971343993NN
malnutrition0.041835863322702NN
educational0.0683326727248364JJ
outcome0NN
nutritional0JJ
status0NN
disease0.103230094596636NN
audit0NN
environmental0JJ
benefit0NN
world0.00438651305628668NN
bank0NN
forest0.041835863322702NN
natural0.0214003646985842JJ
resource0.0104991907358033NN

The Office of the Publisher has chosen to print Environmental Health and Child Survival Epidemiology Economics Experiences on recycled paper with percent postconsumer fiber in accordance with the recommended standards for paper usage set by the Green Press Initiative nonprofit program supporting publishers in using fiber that is not sourced from endangered forests

Label: 15, with a score of: 0.47973085216769
WordScorePoS
environmental0JJ
health0NN
child0NN
economics0NNS
experience0NN
recycle0VB
accordance0NN
recommend0VB
standard0NN
set0NN
green0JJ
initiative0NN
support0.00794883334420673NN
source0.0232260916751625NN
forest0.380082214408185NN

Label: 3, with a score of: 0.442453918211612
WordScorePoS
environmental0JJ
health0.191387734041787NN
child0.10682408961305NN
economics0NNS
experience0.0249430985430622NN
recycle0VB
accordance0.00914534810831654NN
recommend0.0407408489778079VB
standard0NN
set0NN
green0JJ
initiative0NN
support0.00625975725959118NN
source0NN
forest0NN

For more information visit www

Label: 9, with a score of: 0.750008629339307
WordScorePoS
information0.0675706773907211NN

Label: 12, with a score of: 0.405522447948709
WordScorePoS
information0.0365348149782971NN

greenpressinitiative

Label: 0, with a score of: 1

Saved trees million BTUs of total energy lbs

Label: 7, with a score of: 0.926695005879889
WordScorePoS
save0IN
tree0NN
total0.0528748274225028NN
energy0.494617163780726NN

Label: 12, with a score of: 0.306072919234196
WordScorePoS
save0IN
tree0NN
total0.0468670845659596NN
energy0.133960988253756NN

of CO equivalent of greenhouse gases gallons of waste water pounds of solid waste This rigorous study is godsend to anyone involved in advocacy for water and sanitation in developing countries

Label: 6, with a score of: 0.832408201775837
WordScorePoS
equivalent0JJ
greenhouse0NN
gas0NN
waste0NN
water0.556409482163189NN
study0NN
involve0VB
sanitation0.334686906581616NN
develop0VB
country0NN

Label: 12, with a score of: 0.497818846797855
WordScorePoS
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Until now proving that environmental health measures make good sense economically has been tricky business

Label: 3, with a score of: 0.515657132989363
WordScorePoS
environmental0JJ
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Label: 9, with a score of: 0.406266625047609
WordScorePoS
environmental0.0221298700466866JJ
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Label: 1, with a score of: 0.399036865959596
WordScorePoS
environmental0.0442083771593746JJ
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Label: 12, with a score of: 0.363158501720719
WordScorePoS
environmental0.0598270388037045JJ
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Label: 10, with a score of: 0.347577276281832
WordScorePoS
environmental0.0237821918091848JJ
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Now this rigorous and detailed study shows that inadequate environmental health has huge costs to the economy about percent of the GDP of typical developing countries in addition to the pain and suffering they cause

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study0NN
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For politicians who are unmoved by arguments that failure to invest in water and sanitation will make their people poor this study offers clincher it shows how lack of investment will also negatively affect their children's educational and cognitive performance because of the effects of malnutrition exacerbated by frequent episodes of illness

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WordScorePoS
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Sandy Cairncross Professor of Environmental Health London School of Hygiene and Tropical Medicine Recent research has highlighted once more that improved environmental services and conditions can play an essential role in reducing child mortality

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WordScorePoS
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WordScorePoS
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WordScorePoS
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Additional insights in the economic evaluation at country level therefore provide timely information for the design of policy action

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WordScorePoS
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WordScorePoS
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Maria Neira Director Department of Public Health and Environment The World Health Organization Child survival is probably the most important and the most elusive development goal particularly in Sub Saharan Africa and South Asia

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WordScorePoS
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One reason is that it has traditionally been treated only as health issue whereas as this book clearly shows the determinants often lie outside health in water sanitation and other environmental factors

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WordScorePoS
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WordScorePoS
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WordScorePoS
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To treat this multi sectoral problem we need multi sectoral effort

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WordScorePoS
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This book provides guidance and inspiration for that effort

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Shantayanan Devarajan Chief Economist Africa Region former Chief Economist South Asia Region The World Bank ISBN SKU

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SDGCOUNT
1622
2576
31767
4319
5269
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7130
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10519
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17288

RelationCOUNT
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